COURSE ENQUIRED FOR *

Date: 16/06/2021

NAME OF APPLICANT *

MOBILE NO. *   

GENDER *

HIGHEST QUALIFICATION *

10+2 PASSING YEAR * 

STREAM *

Total %age in 10+2 *

GAP Year (Yes/No) *

MARKS IN PCB

Physics * 

Chemistry * 

Biology * 

Total PCB %age * 

NAME OF SCHOOL (LAST ATTENDED) *

DATE OF BIRTH  Age min 17yr till Dec 30, Max 30yr for ANM, 35 yrs For Bsc/GNM (General) *  

AGE * 

FATHER'S NAME *

MOBILE NO. *   

FATHER'S OCCUPATION *

MOTHER'S NAME *   

MOBILE NO. *   

MOTHER'S OCCUPATION *

CATEGORY  *

ANNUAL FAMILY INCOME (IN RS.) * 

DOMICILE STATUS *

NATIONALITY *

PERMANENT ADDRESS *

E-MAIL ID *