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Application No: B.SC (Nursing) Programme - Application Form - 2020

1. The document is an application form for admission to the B.Sc Nursing program at Dr. Vimal College of Nursing in Vellore, Tamil Nadu for 2020. 2. It requests personal information from applicants such as name, date of birth, address, family details, academic qualifications, extracurricular activities, and reasons for choosing nursing. 3. It requires declarations from both the applicant and parent/guardian acknowledging the college rules and accepting financial responsibility for tuition fees if admitted.

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ashamartina
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Download as DOCX, PDF, TXT or read online on Scribd
80 views

Application No: B.SC (Nursing) Programme - Application Form - 2020

1. The document is an application form for admission to the B.Sc Nursing program at Dr. Vimal College of Nursing in Vellore, Tamil Nadu for 2020. 2. It requests personal information from applicants such as name, date of birth, address, family details, academic qualifications, extracurricular activities, and reasons for choosing nursing. 3. It requires declarations from both the applicant and parent/guardian acknowledging the college rules and accepting financial responsibility for tuition fees if admitted.

Uploaded by

ashamartina
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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A Dr.

Vimal College of Nursing


Approved by Tamilnadu Nurses and Midwives Council Chennai-14
Affiliated to The TN Dr M.G.R Medical University Chennai 32
Recognized by Indian Nursing Council New Delhi
(Near Government Vellore Medical College and Hospital, TB Sanatorium Post, Dharmavaram Road.
Pennathur post. Vellore 632011
Contact :+91- 7094497300 |+91- 9488690605| +91-7539965807
Email: [email protected]
Website: www.vimalcollegeofnursing.com

B.Sc (Nursing) PROGRAMME – APPLICATION FORM - 2020 Paste your recent


passport size
Application No Photo
(Only for Office Use)
(51 x 51 mm)
(The Application form is to be completed by the applicant in her own handwriting)

1. Name of the Applicant :


(In Block Letters as in School records)

2. Date of Birth : D D M M Y Y Y Y

3. Religion :

4. Caste (SC/ST/BC/MBC/OC)
(For Administrative Purpose one) :

5. Nationality :

6. Present Address :

7. Permanent Address :
1
8. Mother Tongue :

9. Language Known :

Speak :

Read :

Write :

10. Academic Qualification

Exam
Year of Marks Year of
Passe Name of the School Board Subjects
Passing obtained Passing
d
English

Physics

Chemistry

Biology

Botany

Zoology

TOTAL

Over all Percentage: Physics/ Chemistry/Biology(%) : Total Marks :

(Attach your Xerox copies of your certificates, (Mark list, TC, Community Certificate)

11. Any other Qualification :


A Dr. Vimal College of Nursing
Approved by Tamilnadu Nurses and Midwives Council Chennai-14
Affiliated to The TN Dr M.G.R Medical University Chennai 32
Recognized by Indian Nursing Council New Delhi
(Near Government Vellore Medical College and Hospital, TB Sanatorium Post, Dharmavaram Road.
Pennathur post. Vellore 632011
Contact :+91- 7094497300 |+91- 9488690605| +91-7539965807
Email: [email protected]
Website: www.vimalcollegeofnursing.com

12. Personal Information


(Family Profile)
Name Age Education Occupation Annual Income
Father

Mother

Brother/Sister

1.

2.

3.

4.

5.

13. State any scholarship or special honors, you have received in your School career:

14. List any organization or activities in which you participated in School:

15. State your hobbies and interests:

16. Mention the reasons for choosing Nursing:

17. DECLARATION OF THE CANDIDATE

3
I declare that the entries made by me in this form are true to the best of my knowledge. I have gone through the
prospectus carefully and undertake to abide by all the conditions. I further agree, if admitted, to conform to the rules
and regulations at present in force or that may hereafter be made for the administration of the college or anything that
will interfere with its orderly working and discipline. I hold myself responsible for dues and prompt payment of fees. I
am aware that the management has full authority to expel me for disinterest in studies and/ or misbehavior.

Date: Signature of the Candidate

18. DECLARATION BY THE FATHER / GUARDIAN

I hereby declare that I hold myself responsible for her good conduct and I have known the financial obligation
and I can afford and undertake to pay the tuition and other fees payable to the Institution under the rules of the College.

Date: Signature of the Father/Guardian

NOTE for the Candidate:

Please enclose the following Xerox copies of documents:


a) 10th Mark Sheet.
b) 12th Mark Sheet.
c) 12th Transfer Certificate.
d) Conduct Certificate from the Head of the Institution, wherein the candidate studied for her qualifying
examination
. e) Xerox copy of the Community certificate.
f) Medical fitness Certificate (from Govt. Medical Practitioner) along with blood grouping certificate.
g) If the candidate is from other state: The following documents has to be produced,
a. Eligibility certificate from The Tamilnadu Dr.M.G.R Medical University, Guindy, Chennai.
b. Migration certificate from the concerned board from where last studied.
h) Hepatitis B & Typhoid Vaccination certificate.
i) Recent Income certificate.

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