Application Form
VYDEHI INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE | ||
NO.82, EPIP area, NALLURHALLI, Whitefield, Bangalore-560066 | ||
PB B.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
PB.BSc.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
| GNM MARKS CARD / INTERN COMPLETION / GNM COMPLETION |
|
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 CANDIDATE
SIGNATURE OF RECIEVER (PRINCIPAL)