RKMS - Shiva Infotech

Application Form for Admission to General Nursing and Midwifery Diploma Course (3 years)

Candidate Details
Declaration
Upload Documents

1. Full name of the candidate *

Image should be uploaded in jpg/jpeg format only.

2. (a) Father's Name *

Father's Occupation *

Father's Mobile No. *

(b) Mother's Name *

Mother's Occupation *

Mother's Mobile No.

Guardian's Occupation *

Guardian's Mobile No.

3. Name of the guardian or name of the person to be contacted in case of emergency*

Emergency Phone No.*

4. Candidate's Date of birth (Attach proof) *

Height (in feet) *

Weight (in kg.) *

5. Religion*

Community *

General

OBC

6. Mother tongue*

Marital Status *

Single

Married

7. No. of Brothers*

No. of Sisters*

8. Other languages known : Speaking

Other languages known : Reading and writing

9. Monthly income of the family (Rs.)*

10. E-mail ID*

11. Full Postal Address*

State *

PIN Code*

Phone No. with STD code

Mobile No.*

12. Total Marks (in %) in 12^th*

13. Subjects taken in 12^th*

14. Any other qualification / experience

15. Whether any of your relatives studied in Ramakrishna Mission School of Nursing, Vrindavan :

If yes, let us know the year of Study and the name of relative

I do hereby, declare that I have read the prospectus, and if selected, shell abide by all the rules and regulations printed in prospectus.

Image of Signature of the Candidate

I, of Ms. * do hereby agree to her joining the three years GNM course at Ramakrishna Mission Sevashrama School of Nursing, Vrindavan. I have read and / or understood the prospectus and agree to abide by the rules and regulations. I do hereby confirm that I shall appear personally before the Ashrama authorities within 2 Days as and when called for.

Image of Signature of the Parents/Guardian

All Documents should be uploaded in PDF format only.

10^th Certificate*

10^th Marksheet

12^th Certificate*

12^th Marksheet

Aadhaar Card

Income Certificate

Birth Certificate

Important:

Please bring 10th marksheet, 10th certificate, 12th marksheet, 12th certificate, Aadhar card, Transfer Certificate, Migration certificate, Income Certificatee, Character certificate, Caste certificate and birth certificate in original at the time of Admission test.

Payment Amount*

DD No.*

DD Date *

DD Drawn on *

*Mandatory Fields

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