Form Fee: Rs.300/-

KADI SARVA VISHWAVIDYALAYA - GANDHINAGAR

(A UNIVERSITY ESTABLISHED VIDE STATE ACT OF GUJARAT AND RECOGNISED BY UGC)

APPLICATION FORM FOR ADMISSION INTO POST BASIC B.Sc., (Nursing) Course

for the year 2012-13

Registration No. ______

1. Name of the Candidate (IN BLOCK LETTERS)

2. Father’s Name:

3. Address for Communication:

Pin Code

4. Nationality:- ______Ph No (Res) ______(Off)______

Mb No:-______Email.Id.______

Date Month Year

5. Date of Birth:

Open / SEBC / SC / ST

6. (a) Category:-

Yes / No

(b) Claiming Physically Challenged reservation (PH):

7. Educational Particulars of Study:

SI. No. / Class / Stream / Board / Year / Percents (%)
1 / S.S.C.
2 / H.S.C.

8. Particulars of GNM Course:

a) Date of Registration: ______

b) Name of Council: ______

c) Registration Number

d) Name of School of Nursing: ______

______

e) Result of GNM.

Course / No. of Attempts / Year of Passing / Maximum Marks / Marks Obtained / Percentage (%)
GNM (1st year)
GNM (2nd year)
GNM (3rd year)
GNM (Internship)

9. Details of Demand Draft:

(1) D.D Number ______(2) Bank Name:- ______

(3) Place ______(4) Amount ______(5) Date______

DECLARATION

I here by affirm that the statements made and information furnished by me in the application form and also in all the enclosures thereto submitted by me are true and correct. I have not kept any information secret. Should it however be found that any information furnished therein is fraudulent, incorrect or and true in material particulars, I realize that, I am liable to criminal processions and also agree to forgo my seat in the college. Further, that the selection and admission to the course is liable to be cancel. I shall abide by the decision of the nursing admission committee and of the Registrar, Kadi Sarva Vishwavidyalaya, Gandhinagar. The final decision shall be binding on me.

SIGNATURE OF FATHER / GUARDIAN SIGNATURE OF THE APPLICANT

Attach Document with form

1.  S.S.C and H.S.C Mark sheet

2.  G.N.M all Years Mark sheet

3.  Registration Certificate of State Nursing Council

4.  Course completion Certificate

5.  Leaving Certificate

6.  Cast Category Certificate

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