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 вЂ“ CandidateвЂ™s Copy Entrance Exam for admission to Post Basic B.Sc. Nursing (2 years) course October, 2014 Roll No. Name of Centre -вЂ“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 FatherвЂ™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 вЂ“ 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 FatherвЂ™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