Application Form
VYDEHI INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE | ||
NO.82, EPIP area, NALLURHALLI, Whitefield, Bangalore-560066 | ||
B.Sc. Nursing | ||
STUDENT DETAILS FORM | ||
Sl.No | List | Details |
1 | Student name |
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2 | Date of Birth |
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3 | Blood group |
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4 | Mother Name |
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5 | Mother Mob. No |
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6 | Mother E-mail id |
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7 | Father Name |
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8 | Father Mob. No |
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9 | Father E-mail id |
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10 | Permanent Address |
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11 | Present Address |
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12 | Student Mob No: |
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13 | Student E-mail id |
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14 | Gender |
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15 | Religion |
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16 | Caste |
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17 | Caste Category |
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18 | Nationality |
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19 | State |
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20 | Seat Category (Management/Govt.) |
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21 | Qualification Exam | |
ACKNOWLEDGEMENT OF RECEIVING ORIGINAL CERTIFICATE OF B.Sc. NURSING 2022-23 BATCH
NAME OF THE STUDENT:___________________ FATHER’SNAME:_______________________
MOTHER’SNAME:___________________________ PARENT MOB NO:______________________
CANDIDATE MOB NO: ___________________
SL NO | CERTIFICATES | SUBMITTED / NOT SUBMITTED |
1
| 10TH MARKS CARD |
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2
| 12TH / PUC MARKS CARD |
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3
| TRANSFER CERTIFICATE |
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4
| MIGRATION CERTIFICATE (OTHER THAN PU BOARD) |
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5
| ELIGIBILITY CERTIFICATE – RGUHS (OTHER THAN PU BOARD) |
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6 | STUDY/ CONDUCT CERTIFICATE |
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7
| PHYSICAL FITNESS CERTIFICATE |
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8
| ALL CERTIFICATES 2 SETS XEROX COPIES WITH ATTESTATION BY GAZETTED OFFICER |
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9 | PASSPORT SIZE PHOTOS 5 NO + 5 NO STAMP SIZE |
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10 | XEROX COPY OF FEE PAID RECEIPT |
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11 | XEROX COPY OF PAN CARD AND AADHAR CARD OF PARENTS |
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12 | XEROX COPY OF AADHAR CARD OF STUDENT |
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13
| ANTI RAGGING AFFIDAVIT (FORMAT ENCLOSED ,NOTARY HAS TO BE DONE FROM BANGALORE) |
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14
| OTHERS |
SIGNATURE OF PARENT/GUARDIAN
SIGNATURE OF CANDIDATE
SIGNATURE OF CANDIDATE
(PRINCIPAL)
UNDERTAKING
I Mr/Miss._______________________________ -D/o., S/o Sri.____________________________________ Admitted to B.Sc. Nursing at (VINS & RC), Bangalore on-______________________________ for the academic year 2021-22 under MGT/ GOVT & NRI quota. I have not submitted the following original documents at the time of admission. I will submit the same on or before-___________________________ failing to submit required documents I hold personal responsibility for non-approval of my admission to RGUHS.
SL NO | REQUIRED DOCUMENTS |
1
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2
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3
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4
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5
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6
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7
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Signature of the Parent
EMAIL ID
Signature of the Student
EMAIL ID