Admission Form

Nij Sindurighopa

Changsari, Kamrup(R)

Pin: 781101

Phone: 7896049792/93, 9864043684

Fax: (0361)2608262


Father's details

Mother's details

Permanent address

Present address

Name and Address of Guardian

(in case of SC/ST candidate copy of supporting document to be enclosed)

Academic Particulars

Exam Passed Name and address of the school/college Name of the Board/University Percentage Yr. of pass Private or regular Remarks if any

H.S./10+2 (Science)(Arts)

Any other qualification

Details of 10+2

Subjects Total Marks Total Marks Obtained Percentage


Declaration by the candidate

I hereby declare that I have filled this form to be best of my knowledge and belief that all the particulars given above are true.

I hereby undertake to abide by all the conditions, rules and regulations in force at present and also those which may hereafter be introduced for the administration of the college. I will do nothing unworthy as a student of the college either inside or outside or anything that will cause harm to its orderly working and discipline. I am aware that the management has the full authority to expel me for disinterest in studies, misbehaviour, continuous failure and for any other valid reasons.

I hereby undertake that I shall pay all the fees and other dues to the institution promptly on demand. I have thoroughly read the prospectus and understood the contents therein. I am lawfully bound to pay fees for the whole course period withdraw from the college anytime after admission and or before completion of the course.

Undertaking by Father/Mother/Guardian

Today, the

day of


I, Sri/Smti

Father/Mother/Guardian of

Resident of

Police Station


have read the prospectus and undertaken to pay all dues/fees as applicable for my Son/Daughter/Ward for undergoing the ANM/ GNM/ B. Sc/ Post Basic B.Sc. nursing course. This amount may beforfeited if the student fails to complete the course or is dismissed from the college on account of misconduct orother valid reason. I being the father/mother/guardian hereby undertake to pay full fees/dues to the institutionfor the whole course period if my ward withdraw/expel from the institution any time after admission and before completion of the course.

1. Witness: (Optional)

2. Witness: (Optional)

Attested copies of certificates, passport photo and signatures to be enclosed/attached.

Note:- Supported file formates JPG, PNG or PDF files. Upload file size limit 1 MB for each file.

Passport size photo of student

HSLC/10+ Admit Card

HSLC/10+ Marksheet

HSLC/10+ Pass Certificate

HS/10+2 (Science or Arts) Admit Card (Optional)

HS/10+2 (Science or Arts) Marksheet

HS/10+2 (Science or Arts) Pass Certificate

Conduct certificate (Optional)

Caste certificate (Optional)

Brith certificate

Preliminary Medical Fitness Certifi cateby authorised doctor

Migration Certificate (Optional)

Transfer Certificate (Optional)

RN/RM Certificate (for Post Basic B.Sc. Nursing) (Optional)

Declaration signature of the Parents/Legal Guardian

Declaration Signature of applicant

Undertaking Signature of Father/Mother/Guardian

Witness NO. 1 Signature (Optional)

Witness NO. 2 Signature (Optional)