Application Form
| VYDEHI INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE | ||
| NO.82, EPIP area, NALLURHALLI, Whitefield, Bangalore-560066 | ||
| M.Sc. 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 M.Sc.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 | 10TH MARKS CARD | |
| 2 | 12TH / PUC MARKS CARD | |
| 3 | B.Sc. MARKS CARD | |
| 4 | TRANSFER CERTIFICATE | |
| 5 | MIGRATION CERTIFICATE (OTHER THAN PU BOARD) | |
| 6 | ELIGIBILITY CERTIFICATE – RGUHS (OTHER THAN PU BOARD) | |
| 7 | STUDY/ CONDUCT CERTIFICATE | |
| 8 | PHYSICAL FITNESS CERTIFICATE | |
| 9 | ALL CERTIFICATES 2 SETS XEROX COPIES WITH ATTESTATION BY GAZETTED OFFICER | |
| 10 | PASSPORT SIZE PHOTOS 5 NO + 5 NO STAMP SIZE | |
| 11 | XEROX COPY OF FEE PAID RECEIPT | |
| 12 | XEROX COPY OF PAN CARD AND AADHAR CARD OF PARENTS | |
| 13 | XEROX COPY OF AADHAR CARD OF STUDENT | |
| 14 | ANTI RAGGING AFFIDAVIT (FORMAT ENCLOSED ,NOTARY HAS TO BE DONE FROM BANGALORE) | |
| 15 | OTHERS |
SIGNATURE OF PARENT/GUARDIAN
SIGNATURE OF RECIEVER
SIGNATURE OF CANDIDATE
(PRINCIPAL)
UNDERTAKING
I Mr/Miss._______________________________ -D/o., S/o Sri.____________________________________ Admitted to 1ST M.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 | |
| 2 | |
| 3 | |
| 4 | |
| 5 |
Signature of the Parent
EMAIL ID
Signature of the student
EMAIL ID