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Registration Form

First Name*

Middle Name

Last Name*

Name (As mentioned in the 10th certificate)*

Email ID*

Phone Number*

Date of Birth*

Age*

Marital Status*

Nationality*

Religion*

Caste*

Father/Mother/Guardian’s Name*

Parent/Gaurdian Contact Number*

Student’s Aadhaar Number*

Is student’s mobile number linked with Aadhaar?*

Address Line 1*

Address Line 2*

Country*

State*

City/Town*

Zip/Postal Code*

Is the student the first graduate in the family? *

Yes No

Colleges*

Course*

M.Sc Nursing Branches *

Post Basic Diploma in Nursing Branches *

Academic Record - Intermediate/12th Standard

Year of Passing*

Main Subjects*

Total Marks %*

PCB %*

Medium of Instruction*

Name of the Institute*

Nursing License Details (for P.B.B.Sc/M.Sc/Post Basic Diploma/Ph.D Nursing Admission)

Name of the Nursing Council

RN Number

Valid Till

RM Number

Valid Till

Employment Details (for M.Sc. Nursing Admission)

Total Years of Experience

Name of the Institution (Current)

Position Held

From

Additional Experience

Languages Known

Speak

Read

Write

Extra-Curricular Activities/Hobbies (Sports/Cultural, etc)

Upload Certificates (Attested)

Educational Qualification (H.Sc./+2)*

10th Marksheet*

Diploma Certificate/Degree Certificate (If Applicable)

GNM Marks List (If Applicable)

Transfer Certificate*

Registration of Nurse and Midwife (If Applicable)

Community Certificate (For SC/ST, BC, OBC and MBC Only)*

Aadhaar Card*

Medical Fitness

Undertaking

I hereby declare that the above particulars are true and correct to the best of my knowledge. I have read the prospectus and fully understand that in the event of my violation of any rules and regulations, I am liable to immediate dismissal from the college. Furthermore, I consent to undergo the course for its full duration. I undertake not to engage in any actions that could cause disrespect or loss of reputation by indulging in malpractices, immoral acts, or illegal acts, which may warrant dismissal from the college.

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