ADMISSION APPLICATION FORM BASIC B.Sc. NURSING
YEAR OF ADMISSION : ACADEMIC YEAR 2024 - 2025
Name: *
Phone No: *
Email: *
Aadhar Card No: *
Bank Details
SB A/c No: *
IFSC Code: *
Bank Name: *
Branch: *
MICR Code: *
Category of Information
Personal Details
Date of Birth: *
Gender: *
Place of birth: *
Taluk: *
District: *
State: *
Nationality: *
Religion: *
Caste: *
SubCaste: *
Category: *
Caste Certificate Rd No:
Income Certificate Rd No:
Ration Card No
Father Name:
Mother Name:
Gurdain Name (If parents not present):
Perment Adress (In Detail) *
Corresponding Address (In Detail) *
Particulars (Father Details)
Father Occupation
Father Income (Annual)
Father Aaadhar No
Father Qualification
Father Contact No
Particulars (Mother Details)
Mother Occupation
Mother Income (Annual)
Mother Aaadhar No
Mother Qualification
Mother Contact No
Particulars (Guardain Details)
Guardain Occupation
Guardain Income (Annual)
Gurdain Aaadhar No
Gurdain Qualification
Guardain Contact No

Academic Details

Particulars ( SSLC 'X')
Registration No *
Month and Year Of Passing *
Board of University *
Attempt *

Subjects Marks

English *
Hindi *
Science *
Maths *
Social Science *
Max Marks of *
Max Marks for *
Max Marks of *
Max Marks of *
Max Marks of *
Max Marks of *
Particulars ( PUC 'XII')
Registration No *
Month and Year Of Passing *
Board of University *
Attempt *
CET No *
CET Rank *

Subjects Marks

Physics *
Chemistry *
Biology *
Maths *
English *
Max Marks for *
Max Marks of *
Max Marks for *
Max Marks for *
Max Marks for *
Max Marks for *
College With Address
Medical Information of Candidate
Height
Weight
Blood Group
Physical Disablity (If Any)
Passport Photo
Student Sign
Parents Sign
SSLC Marks Card
PUC Marks Card
Income Certificate
Caste Certificate
Bank Passbook
Adhar Card
PAN Card
Medical Certificate (only for physical disablity)
Transfer Certificate

DECLARATION BY THE STUDENT

I promise that the particulars furnished by me are true and correct to the best of my knowledge and belief.I understand that my admission is provisional. Further, I hereby declare that I shall abide by the rules and regulations of the College made from time to time.

DECLARATION BY THE PARENT

I agree to my Son / Daughter admission to the 2024 - 2025 year Basic B.Sc. Nursing degree course and shall be responsible for the payment of all his / her fees and charges. I hereby undertake to follow the rules and regulation existing at present and to be informed from time to time.