Admission Form - kihmsnursing

Name *

Father's Name *

Guardian's Name

Date of Birth *

Phone No. *

Course *

Correspondence Address

Permanent Address *

Marital Status *

Any Working Experience

Academic Qualifications (Starting form Matriculation Onwords)

First Qualification

S.r. no.

Class

University/Board

Name of School/Collage

Division & %

Year of Passing

Second Qualification

Third Qualification

Do you Belong to:

Backward Class

Schedule Class

Schedule Tribe

Passed Hindi/State Language upto Matriculation

I hereby declare that the information given in this application is true and correct to the best of my knowledge and belief. In case any information given in this application proves to be false or incorrect, I shall be responsible for the consequences. I also declare that if any information provided by me is found false, my candidature may be rejected at any point of time.