Application form

Admission to P. B. B. Sc. Nursing - 2024-25

First Name:

Father's/Husband's Name:

Mother's Name:

Surname:

Photo:

Date of Birth:

Nationality Status:

Sex:

Domicile:

Mobile No:

Marks obtained in R.G.N.M:

Marks Out of:

Year of Passing R.G.N.M:

Address:

Signature of the candidate.:

Name & Address of College from which the candidate has passed :

District:

State:

Name of parent/Guardian:

Address of parent/Guardian:

Declaration:

1. I hereby declare that the above information is true and complete 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.

2. If admitted to this Institution I shall abide by its rules and regulations.

3. I have read and understood all the provisions contained in the brochure and hereby agree to abide by these provisions.