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Admission Registration Form
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In case of any queries, please call us on : 8889995109 , 9111000301
ANUSHREE COLLEGE OF NURSING JABALPUR
ADMISSION / REGISTRATION FORM.
Course
*
GNM (General Nursing & Midwifery)
B.Sc.Nursing
P.B.B.Sc.N.(Post Basic B.Sc. Nursing)
M.Sc.(Medical and Surgical Nursing)
M.Sc.(Mental Health Nursing)
M.Sc.(Obs.& Gynaecological Nursing)
M.Sc.(Child Health Nursing)
M.Sc.(Community Health Nursing)
Session
2020-21
Name of the applicant
*
Father's / Husband's Name
Mother's Name
Parent Mobile No
Applicant Mobile No.
*
Permanent Address
*
District
PIN
State
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Goa
Gujarat
Haryana
Himachal Pradesh
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Date of Birth
Age
Sex
Male
Female
Blood Group
Nationality
Indian
Married
Yes
No
Cast
SC
ST
OBC
GEN
Cast Certificate
Occupation of Parent
Annual Income
Name of Local Guardian
Address of Local Guardian
Last Exam Passed
Year
Roll No.
Academic Records
Class
10th
Institution
Board
Roll No
Year
Marks
%
Class
12th
Institution
Board
Roll No
Year
Marks
%
We Solemnly affirm that-
We shall abide by rules and regulations of conduct and descipline of institution.
What is stated in the application form, is true to the best of my knowledge and belief.
We shall not indulge ourselves in any antisocial activities during the college tenure. If found the applicant may be rusticated. The decision of the college authorities shall be final and binding on us.
Fees Deposited will not be refunded until admission is cancelled by college.
Place
Date
उपरोक्त दिए दस्तावेजों के अलावा निम्नलिखित दस्तावेजों को भी प्रस्तुत करें
जी. एन. एम. की अंकसूची / बी. एस. सी. / पोस्ट बेसिक अंकसूची
रजिस्ट्रेशन सर्टिफिकेट
डिप्लोमा या डिग्री सर्टिफिकेट
एन यू आई डी
एफिडेबिट (नियमित छात्र होने का )
अवकाश स्वीकृति प्रमाण पत्र (केवल शासकीय छात्र /छात्राओं हेतु )
सम्बंधित कॉउंसल / माइग्रेशन सर्टिफिकेट
अनुभव सर्टिफिकेट
10th की अंकसूची
12th की अंकसूची
स्थानांतरण प्रमाण पत्र
जाती प्रमाण पत्र (डिजिटल)
मूल निवासी / जन्म प्रमाण पत्र / पासपोर्ट (डिजिटल)
आधार कार्ड
समग्र आई डी
मेडिकल फिटनेस सर्टिफिकेट ( सर्टिफिकेट शासकीय अस्पताल से बना होना चाहिए जिसमे चिकित्सक का रजिस्ट्रेशन नंबर लिखा होना चाहिए )
पासपोर्ट फोटो - 4
एंटी- रैगिंग एफिडेबिट छात्र एवं पालक का