Application Form

VYDEHI INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE
NO.82, EPIP area, NALLURHALLI, Whitefield, Bangalore-560066
G.N.M Nursing
STUDENT DETAILS FORM
Sl.No	List	Details
1	Student name
2	Date of Birth
3	Blood group
4	Mother Name
5	Mother Mob. No
6	Mother E-mail id
7	Father Name
8	Father Mob. No
9	Father E-mail id
10	Permanent Address
11	Present Address
12	Student Mob No:
13	Student E-mail id
14	Gender
15	Religion
16	Caste
17	Caste Category
18	Nationality
19	State
20	Seat Category (Management/Govt.)
21	Qualification Exam

ACKNOWLEDGEMENT OF RECEIVING ORIGINAL CERTIFICATE OF GNM NURSING 2023-24 BATCH

NAME OF THE STUDENT: _______________________

FATHER’S NAME:________________________________ MOTHER’S NAME: ___________________________

PARENT MOB NO:______________________________ CANDIDATE MOB NO: ________________________

SL NO	CERTIFICATES	SUBMITTED / NOT SUBMITTED
1	10^TH MARKS CARD
2	12^TH / PUC MARKS CARD
3	TRANSFER CERTIFICATE
4	MIGRATION CERTIFICATE (OTHER THAN PU BOARD)
5	DATE OF BIRTH CERTIFICATE
6	STUDY/ CONDUCT CERTIFICATE
7	PHYSICAL FITNESS CERTIFICATE
8	ALL CERTIFICATES 2 SETS XEROX COPIES WITH ATTESTATION BY GAZETTED OFFICER
9	PASSPORT SIZE PHOTOS 5 NO + 5 NO STAMP SIZE
10	XEROX COPY OF FEE PAID RECEIPT
11	XEROX COPY OF PAN CARD AND AADHAR CARD OF PARENTS
12	XEROX COPY OF AADHAR CARD OF STUDENT
13	ANTI RAGGING AFFIDAVIT (FORMAT ENCLOSED ,NOTARY HAS TO BE DONE FROM BANGALORE)
14	OTHERS

SIGNATURE OF PARENT/GUARDIAN

SIGNATURE OF CANDIDATE

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