Beruflich Dokumente
Kultur Dokumente
3.Father’s/Guardian'sOccupation:---------------------------------------------------------------------
4.Father's/Guardian'sIncome:-------------------------------------------------------------------------
5.Sex:------------------------------- PHOTO
6.PostalAddressforCommunication---------------------------------------------
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Phone:STD.Code.-
7.PermanentAddress:--------------------------------------------------------------------------------------
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Phone:-
8.a.DateofBirth---------------------------------------
b.PlaceofBirth-------------------------------------
9.YearofPassingPUC/Equivalent:--------------------------------------
10a.HigherExaminationpassed 1.Regd.No-----------------------------
b.MediumofInstructioninPUC/PDCOre 2.Month&Year------------------------
quivalentExamination 3.MaximumMarks--------------------
4.MarksObtained---------------------
b.TotalPercentageinPCB -------------------------------------------------------------------
12.a.Religion--------------------------- b.Cast--------------------------------------
13.a.Nationality:---------------------- b.Domicilestatus------------------------
DECLARATIONBYTHEAPPLOCANTANDPARENT/GUARDIAN
DearSir,
IhavegonethroughtheCollegeProspectus,doherebypromisetoabidebyallrulesandregulationsnowi
nforceandthosetobemadefromtimetotime.Iknowthatthefeepaidbymeisnotrefundable,transferableora
djustabletootherpartsorsubjects.IrequestyoutoadmitmeasoneofthestudentofRoohiSchoolofNursing.
SignatureofParent/Guardian SignatureofApplicant
(MEDICAL EXMINATION)
Height----------------------Weight--------------------Sight:--------------------Teeth:-----------------
Lungs--------------------Vaccinated----------------Hearings-------------BloodGroup--------------
WeathertheCandidatehassufferedfromanyofthefollowing:
(a).T.B.-------------------------------------------------(b).RheumaticFever-------------------------
(c).Mental/NervousDisorder------------------------(d)VaricoseVeins-----------------------------
(e).Rheumatism----------------------------------------(f)CardiacDisease----------------------------
(g)Gynecologicalabnormalities--------------------(h)Dental-----------------------------------
ALLERGICTO:
REMARKS:
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Thisistocertifythat,IhaveexaminedMr./Miss.----------------------------------------
andthatHe/Shedoesnothaveanydiseaseconstitutionalweaknessorbodilyinfirmityinher/him.
Iconsiderher/himtobefittoundergotheabovementionedcourse.
Date----------------------
Place--------------------- Seal&Signature
ofMedicalPractitioner
Reg.No.
ProvisionallyadmittedtotheaboveCoursefromtheAcademicyear200 -200
VerifiedOriginalCertificates
10thMarksCard
AdmissionNo. PUC/PDC/+2MarksSheet
TransferCertificate
MigrationCertificate
DateofAdmission: CertificateConduct
Secretary Principal