Student Registration Form
Please fill all the compulsary fields (Marked with *)
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Course Details
Select Course *
*
Select Course Category
B Sc. Nursing
M Sc. Nursing
A.N.M.
G.N.M
Post Basic B. Sc. Nursing
Candidate's Details
Name (English) *
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Name (Hindi) *
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Category *
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Select Category
General
SC
ST
OBC
Physically Handivapped
Ward of Freedom Fighter
Other
Blood Group *
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Select Blood Group
A+
A-
B+
B-
O+
O-
AB+
AB-
Mobile Number *
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Email ID *
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Aadhar Number *
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Samagra ID *
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Date Of Birth *
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Candidate's Mother's Details
Mother's Name (English) *
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Mother's Name (Hindi) *
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Mother's Mobile Number *
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Mother's Occupation *
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Candidate's Father's Details
Father's Name (English) *
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Father's Name (Hindi) *
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Father's Mobile Number *
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Father's Occupation *
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Candidate's Local Contact Details
Local Address *
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District *
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State *
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Local Zip Code *
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Local Contact Number *
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Candidate's Permanent Contact Details
Permanent Address *
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District *
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State *
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Zip Code *
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Permanent Contact Number *
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Is the Applicant Resident of M.P. *
*
Select
Yes
No
Nearest Stop *
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Candidate's Local Gaurdian Details
Local Gaurdian's Name *
*
Local Gaurdain's Relation *
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Local Gaurdian Address *
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District *
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State *
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Zip Code *
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Contact Number *
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Mobile Number *
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Candidate's Qualification Details
Exam
Passing Year
Board/ University
School/ College
City
Roll No.
Marks Obtained
Percentage
Remark
10th
12th
A.N.M.
G.N.M.
B.Sc(N)
P.B.B.Sc(N)
If not appeared in any exam last year, give reason (Attach Gap Certificate)
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Extra Curricular Activity *
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Literary / Cultural *
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Select
Literary / Cultural Yes
Literary / Cultural No
NCC / NSS *
*
Select
NCC / NSS Yes
NCC / NSS No
Sports *
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Select Category
Sports Yes
Sports No
Others *
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Is the applicant employed ? *
*
Select
Yes
No
Has the Applicant ever been convicted by the court of law / university or college or college or is any case pending again him / her regarding indiscipline, use of unfair means, misconduct / or criminal activities etc. Give the separtae details
*
Select
Yes
No
School / College last attended
Name of Prinipal *
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School / College Full Name *
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School Address *
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District *
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State *
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Pin Code *
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School Contact Number *
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Refrence Person( If Any) *
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Did you submit the Fee
Yes
No
Payment Details
Please Make your fee Payments in following Bank, Details are Given Below
Account Number
900610210000013
IFS Code
BKID0009006
