Admission Form

Nij Sindurighopa
Changsari, Kamrup(R)
Pin: 781101

Phone: 7896049792/93, 9864043684
Fax: (0361)2608262

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

Father's details
Mother's details
Permanent address
Present address
Name and Address of Guardian
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
Details of GNM Course(for Post Basic B.Sc Nursing Course)
Total Marks Marks Obtained Percentage Division Remarks
1st year
2nd year
3rd year
3rd year
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

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
GNM Marksheet
GNM Certificate
Conduct certificate (Optional)
Caste certificate
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)