f WELCOME TO ONLINE ADMISSION:2017-18 rr
APPLICATION FORM FOR BASIC B.Sc. NURSING COURSE-2017-18
  * Mark fields are mandatory
1. Full Name Of The Candidate *:
(As recorded in H.S.C):
   
2. Sex :    
3. Category: General S.C S.T      P.H
4. Date Of Birth *:    
5. Age Till December 2017 *:    
6. Nationality *:    
7. Maritial Status: Married Unmarried   
8. Religion *:    
9. Educational Qualification *:    
10. Permanent Home Address *:    
11. Present Address *:    
12. Contact No. MOBILE:   
LANDLINE:   
13. Father's Name *:    
       Occupation *    
         Address *    
14. Guardian's Name *:    
       Occupation *    
        Address *    
       Relationship with Candidate:
15. Academic Details:  
       Name Of The Examination:  (+2 Science or its equivalent)  
       Name Of The Board/University/Council:    
16.
Name of the Examination Mark Without
Ext. Opt.
Percentage
without Ext. Opt.
Percentage of the mark
secured
   
16.  Mark secured in 10 + 2 Science Examination
Subject Maximum Mark Mark Secured Percentage(%)
ENGLISH            
PHYSICS            
CHEMISTRY            
BIOLOGY            
GRAND TOTAL            
17. Upload Your Photo