APPLICATION FORM FOR

M. Sc. Nurse Practitioner in Emergency & Trauma Care Entrance - 2024

Candidate’s Name (As in Degree certificate):

Address:

Pin:

Candidates Photograph:

Candidates signature:

State:

E-Mail:

Sex:

Date of Birth:

STD Code & Telephone No:

Mobile Number:

Nationality:

Name of College & University where you have Passed B.Sc./ P.B.B.Sc. Nsg:

Examination	Board/University	Year of Passing	Attempt	Total Marks Obtained	Out of	Percentage
1 st Year
2 nd Year
3 rd Year
4 th Year

Other post graduate qualification:

If Yes, Other post graduate qualification then give details:

Examination	Board/University	Year of Passing	Attempt	Total Marks Obtained	Out of	Percentage

Admitted to any other PG Course:

If Yes,Admitted to any other PG Course then give details:

Declaration – I:

a. I hereby declare that the above information is true and comlete to the best of my knowledge. I am aware that, if any information herein is found to be incorrect or incomplete, my application form will be rejected/ admission will be cancelled.

b. If admitted to Krishna Institute of Nursing Sciences, Karad of Krishna Institute of Medical sciences “Deemed To Be University”, Karad. I shall abide by its Rules and Regulations.

c. I have read and understood all the provision contained in the broacher and hereby agree to abide by these provisions.

Oh snap!

Yay!