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SANKANUR INSTITUTE OF NURSING GADAG
( UNIT OF UDYOG MAHITI HAGU TARABETI KENDRA )
RECOGNISED BY GOVERNMENT OF KARANATAKA AFFILIATED TO RGUHS
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
KEA Govt
KEA Private
Management
Personal Details
Date of Birth:
*
Select Date
Select Date
Gender:
*
Place of birth:
*
Taluk:
*
District:
*
State:
*
Nationality:
*
Religion:
*
Caste:
*
SubCaste:
*
Category:
*
Caste Certificate Rd No:
Income Certificate Rd No:
BPL
APL
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
*
Kannada
Sanskrit
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
*
Kannada
Sanskrit
Hindi
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
Upload photo
Student Sign
Upload Signature
Parents Sign
Upload Parent Signature
SSLC Marks Card
Upload SSLC Marks Card
PUC Marks Card
Upload PUC Marks Card
Income Certificate
Upload Income Certificate
Caste Certificate
Upload caste Certificate
Bank Passbook
Upload Passbook copy
Adhar Card
Upload Adhar card
PAN Card
Upload PAN card
Medical Certificate (only for physical disablity)
Upload Medical Certificate
Transfer Certificate
Upload 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.
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