College Application Form

Application No

Academic Year

Course Applied For *
Select CourseDGNM (Diploma in General Nursing & Midwifery)B.Sc Nursing (4 Years)

1. Name Of The Applicant * (In Block Letters)

2. Age *

3. Gender *
SelectMaleFemaleOther

4. Date Of Birth *

5. Place Of Birth *

6. Marital Status *
SelectSingleMarriedDivorcedWidowed

7. Mother Tongue *

8. Nationality *

9. Religion *
SelectHinduMuslimChristianOther

10. Community *
SelectBCMBCSCSTOCOther

11. Caste *

12. Blood Group *
SelectA+A-B+B-O+O-AB+AB-

13. Adhar Number *

14. PAN Number

15. Mobile Number *

16. Email Id *

1. Father's Name *

2. Occupation

3. Contact Number *

4. Mother's Name *

5. Occupation

6. Contact Number

7. Annual Family Income: ₹

8. Guardian Name (If Applicable)

9. Guardian Contact Number

PERMANENT ADDRESS:

PRESENT ADDRESS:

Group Studied *
SelectScience (Maths Bio)Science (Bio)VocationalOthers

PCB Percentage

Application Fee Amount

Mode Of Payment *
Select ModeOnline methodOffline method