Registration Form

S.S COLLEGE OF NURSING

Near Agnihotri Eye Hospital, Barwala Road, Hisar-125001, India

Recongnized by HNRC & INC, New Delhi

PT. B.D.S UNIVERSITY OF HEALTH SCIENCE, ROHTAK

Application for REGISTRATION To ANM/GNM/MPHW/Post B.Sc Nursing/B.Sc Nursing/M.Sc Nursing/D.Pharma

REGISTRATION FORM

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Instruction:

Candidate should read the Rules & Regulations before filling the form.
Incomplete form will not be entertained.

* Mandatory

Name *

Name

Father's Name *

Name

Father's Occupation,Organisation Add & Phone:

Name

Guardian's Name

Name

Date of Birth

Name

Category of the applicant

Name

Nationality

Name

Present Address for correspondence

Name

Phone no

Name

Email Id

Name

Permanent Address

Name

Academic Qualifications (Starting from Matriculations onwards)

Class with
Roll no.

University/
Board

Name of
School/College

Division & % with
marks obt. Total

Year of
passing

Subjects

Any working Experience

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Marital Status: Single, Widow! Divorced (without encumbrances)

Hobbies such as Music, Dance, Painting, Sports etc

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I wish to apply for admission to the first year Bsc(H), PBsc(H), GNM & ANM
I have read the rules and I have understood the same. I understand that individual intimation of the selection will not be sent to me
The decision of the selection board of the school will be final and binding on me in all respects.

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Registration

S.S COLLEGE OF NURSING

REGISTRATION FORM

Instruction:

Academic Qualifications (Starting from Matriculations onwards)