MAR BASELIOS COLLEGE OF NURSING, BHOPAL

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Sharlene Hardy
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1 Form No. MAR BASELIOS COLLEGE OF NURSING, BHOPAL APPLICATION FORM B Sc Nursing ( ) Affix latest passport size photograph All entry should be filled in Capital Letter. Leave one blank box between each word. Mark wherever asked/required 1. Name of Student : 2. Date of Birth : DD MM YYYY 3. Caste : General OBC S.C S.T. 4. Religion : Hindu Muslim Christian Any Other 5. Nationality : 6. Father's Name : 7. Father's : Occupation 8. Mother's Name : 9. Mother's : Occupation 10. Annual Income 11. Permanent : Address 12. Present Address : City District State Pin Code City District State Pin Code Telephone No. : Mobile No : E.Mail ID : STD Code Phone

2 13. Educational Profile : Class 10th Std. 12th Std Marks Obtained (P.C.B.E.) Physics Chemistry Biology English Total Marks (PCBE) Percentage Name of Board Maximum Marks Percentage Mark Obtained Date:. Place:. Signature of Candidate

3 DECLARATION BY CANDIDATE I Ms. D/o hereby declare that I have carefully read and understood the conditions of eligibility for the B.Sc. Nursing Course for which I am seeking admission. I fulfill the minimum eligibility criteria and have provided necessary information in this regard. In the event of any information being found incorrect or misleading, my candidature shall be liable to cancel anytime by the college authority. In such case I shall not be entitled to get refund of fee paid by me. I also understood that my admission will be provisional till university provides eligibility for B.Sc. Nursing Courses. I also declare that after admission if any mishaps made by me my admission will be liable to cancel. I hereby also declare that if I found guilty in any act like ragging/strike my candidature will be liable to cancel with immediate effect. Date:. Place:. Signature of Candidate DECLARATION BY PARENTS/GUARDIAN I Mr./Mrs..... parent of Ms.. hereby declare that I have understood all the conditions/rules and regulation for admission and during the study of courses. I am willing to admit my daughter Ms. for the B.Sc. Nursing Course. I also declare that after admission if any mishaps made by her, admission will be liable to cancel by the college authority. I also declare that I will pay all dues in time and abide with rule, and regulations. I also declare that change in fee time-to-time and in rules of college will be acceptable to me. If my child leaves the college or rusticated, I will be liable to pay four year fees. Date:. Place:. Signature of Parent

4 MAR BASELIOS COLLEGE OF NURSING BHOPAL ADMISSION LETTER Affix recent self attested passport size photograph Note : Student is required to fill item no 4, 5, Admission No. : 2. Session : Admission Status : Selected 4. Name of Candidate : 5. Father's Name : 6. Postal Address : City District State Pin Code 7. Date & Time of : / /2018 Reporting 8. Place of Reporting : Mar Baselios College of Nursing, 9. You are required to bring St. Thomas Campus, G-Sector, Ayodhya Nagar, Bhopal : 1. Original Certificates with 2 sets of Photo Copies 2. Medical fitness Certificate 3. Adhar Card 4. Passport Size Photograph Fees : Prescribed Fee in Cash or Demand Draft in favour of Mar Baselios College of Nursing, Bhopal 11. Admission will be provisional till university grants eligibility. Principal

5 MEDICAL CERTIFICATE (Candidate to be Examined by a Registered Medical Practitioner only) This is to certify that Ms. D/o Age. has been examined by me on / /2018 to seek admission in B.Sc. Nursing Course. Her examination finding are : B.P. Pulse Respiration Blood Group Hemoglobin Urine Routine History of any past illness CVS CNS Integumentary Nephrology Neurology Sense Organs Genitourinary Menstrual History Comments : She is medically Fit/Unfit to seek admission. (in case of any illness/infirmity please write comments). Place Date Signature of Medical Officer Registration No.& Seal

6 MAR BASELIOS COLLEGE OF NURSING BHOPAL Session: Application No. HOSTEL ADMISSION FORM Affix recent self attested passport size photograph 1. Full Name In Block Letter 2. Date of Birth : / / (DD/MM/YYYY) 3. Name of Parent / Guardian and Address 4. Name of Local Guardian 5. Relation with Candidate 6. Local Address STD Code Mobile No. _ STD Code Mobile No._ 7. Declaration of Parent/Guardian Phone No. Phone No. I Mr/Mrs quardian of Ms declare that Mr/Mrs whose address and Photo given above is local guardian of my daughter. In emergency he/she can be called on behalf of me and also she can be allowed to go his/her home. Signature of Guardian Signature of Local Guardian

DELHI COLLEGE OF FIRE & SAFETY ENGINEERING

No.... DCFSE DELHI COLLEGE OF FIRE & SAFETY ENGINEERING Recognized and Affiliated to Board of Technical Education,Govt of NCT of Delhi W e Se rve f r Fi re Saf et y APPLICATION CUM ADMISSION FORM DO NOT