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Application form for Post Basic B.Sc. Nursing Course - mahatma

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Rs. 1000/-
Mahatma Gandhi University of Medical
Sciences & Technology, Jaipur
RIICO Institutional Area, Sitapura, Tonk Road, Jaipur - 302 022
Phone : +91-0141-2770798, 2771777, 2771001-3
Application Form
for Entrance Examination and Admission to the
Post Basic B.Sc. Nursing (2 years) Course Session 2014-15
[ To be filled by the applicant in capital letters ]
Application Form No.
To be filled in by University
Received Rs. 1000/- vide receipt No.............................
Dated...............
Cashier
1.
To be filled by the Institution
Name of the Candidate (as given in Class X Certificate)
First Name :
Surname :
Photograph
of the
candidate
Contact No.
E-mail ID
Father's Name:
Mother's Name :
2.
Address :
Signature
PIN Code
Tel. No. (R)
Mobile No.
(Telephone Number with STD Code)
( Day )
( Month )
( Year )
3.
Date of Birth
_____________________
4. Nationality :
Place of Birth :
5.
Gender : Male
6.
Category: General
State
Country
Female
SC
ST
OBC
SBC
:: 2 ::
Exam
Passed
S.
No.
Name of
Name of
Marks Percentage
Max.
Remarks
Year Board/University School/College Subjects
Marks Obtained of Marks
th
1.
10
2.
Higher Secondary/
Senior Secondary
3.
GNM
In case, the candidate has already appeared at any Entrance Examination as per the guidelines of the Indian Nursing council
conducted by Rajasthan University of Health Sciences, Jaipur or any agency of other State Governments/Universities for
admission to Post Basic B.Sc. Nursing (2 years) course and qualified the same, please give details Entrance
Examination
Passed
Year
Conducted by
(Name of Agency/University)
Marks Percentage
Max.
Remarks
Marks Obtained of Marks
List of enclosures
(1)
(2)
(3)
(4)
Self attested photocopy of class 10th Certificate.
Self attested photocopy of the Marks-sheet of Higher /Senior Secondary examination 10+2 or equivalent .
Self attested photocopy of Marks-sheet of General Nursing and Midwifery (GNM).
Self attested photocopy of General Nursing Midwifery (GNM) Diploma Certificate and State Nursing Council
Registration Certificate.
(5) Self attested photocopy of Marks-sheet of the Entrance Examination if already qualified for admission to Post Basic
B.Sc. Nursing course.
(6) Caste Certificate for Reservation Category - SC/ST/OBC(non creamy layer)/SBC (non creamy layer) etc. if the
candidate belongs to the category, other than General Category.
(7) Physically Handicapped Certificate.
Please Tick ( Гј) the documents you have annexed.
I declare that all the information furnished by me in the application form is true to the best of my
knowledge. If any information found false, my application may be rejected. I will submit my
original Marks-sheets, Caste Certificate, T.C., Migration Certificate, Character Certificate and
other needed Declarations before my admission.
Place -______________
Date -______________
Signature of the applicant
Note : Duly filled in downloaded application form must be brought in person or submitted through post in the office of the Registrar,
Mahatma Gandhi University of Medical Sciences & Technology, Sitapura, Tonk Road, Jaipur - 302 022 before the last date as
mentioned in the Notification.
Application Form shall not be accepted without fee of Rs. 1000/- Cash/DD in favour of Mahatma Gandhi Nursing College
payable at Jaipur. Incomplete application forms and the forms received after the last date due to any reason including postal delay
shall not be accepted.
For future correspondence please quote yourApplication Form number.
Mahatma Gandhi University of Medical Sciences & Technology, Jaipur
ADMIT CARD – Candidate’s Copy
Entrance Exam for admission to Post Basic B.Sc. Nursing (2 years) course October, 2014
Roll No.
Name of Centre -–Mahatma Gandhi University - Examination Hall
Day and Date :of Exam : Wednesday, October 29, 2014
Affix Photo
Exam Time : 11:00 A.M. to 01:00 P.M.
Name of Candidate
Father’s Name
Signature of Candidate
All details in the Admit Card are correct
Signature of Candidate
Sign. & Seal of the Centre Superintendent
Controller of Examinations
Mahatma Gandhi University of Medical Sciences & Technology, Jaipur
ADMIT CARD – Centre Copy
Entrance Exam for admission to Post Basic B.Sc. Nursing (2 years) course October, 2014
Roll No.
Name of Centre - Mahatma Gandhi University - Examination Hall
Day and Date :of Exam : Wednesday, October 29, 2014
Affix Photo
Exam Time : 11:00 A.M. to 01:00 P.M.
Name of Candidate
Father’s Name
Signature of Candidate
All details in the Admit Card are correct
Signature of Candidate
Sign. & Seal of the Centre Superintendent
Controller of Examinations
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