VI JAYSINH MOHITE-PATIL COLLEGE OF NURSING & MEDICAL RESEARCH INSTITUTE, AKLUJ.

Transcription

VI JAYSINH MOHITE-PATIL COLLEGE OF NURSING & MEDICAL RESEARCH INSTITUTE, AKLUJ.
Shivratna Shikshan Sanstha’s
VI JAYSINH MOHITE-PATIL
COLLEGE OF NURSING & MEDICAL
RESEARCH INSTITUTE, AKLUJ.
APPLICATION FORM A FOR ENROLLMENT AND ELIGIBILITY OF UNDER GRADUATE
COURSES OF HEALTH SCIENCES FACULTIES
www.vmpcollegeofnursingakluj.com
Email : [email protected],com
1. Name of Student Shri/Smt/Kum
_______________________________________
(As per HSC Marks Statement)
2. Permanent Address
_______________________________________
3. Telephone/ Mobile No.
_______________________________________
4. Date of Birth:
_______________________________________
5. Nationality:- _____________________
Sex :- _____________________
6. Name of Maharashtra State Board from which passed the HSC/ Qualifying Examination : _________
7. Details of HSC Qualifying Examination: Month & Year of Passing 1)___________ 2) Medium_____
3) Division / Grade:_______________ 4)PCBE Marks :_______________
8. Details of Entrance Examination:
1) Name of CET:______________ 2) Marks Obtained: _______
3) Percentage of Marks:________4) Merit List No:________
9. Admitted Category
10. Quota in which admitted:
1) Free
2) Payment
1) DMER
2) AIEE
3) GOI
3
2)ST
3) VJ
4) NT-1
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3 6) NT-3
3
5) NT-2
7) OBC3
8) OPEN
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12. Specified Reservation Category 1) DEF
2)i PH
3) MKB
4) HA
5) None
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13. Additional Weight age Claim 1) Sport
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14.Date of Admission:
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behalf. If any information is found out incorrect or iuntrue,
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Criminal action may be taken against me.
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Signature
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Certified that the enteries made by the student in the
application
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prescribed by the University.
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11. Constitutional Category of Admission 1) SC
Shivratna Shikshan Sanstha,
Vijaysinh Mohite-Patil College / School of Nursing & Medical Research
Institute, Akluj
DOCUMENTS ATTACHED
1) Nationality / Domicile Certificate
:
2) S.S.C. Marksheet / Board Certificate
:
3) H.S.C. Mark sheet / Board Certificate
:
4) CET Mark sheet (If Applicable)
:
5) Income certificate
:
6) Caste Certificate (If Applicable)
:
7) Validity Certificate (If Applicable)
:
8) Non-Creamy layer Certificate (If Applicable) :
9) School Leaving Certificate (LC / TC)
:
10) Medical Fitness Certificate
:
11) Gap Certificate
: