Shri Shankaracharya College of Nursing
Admission Form
Academic details
Enquiry No
:
Enquiry Date
:
*
Course
:
*
Branch
:
Semester / Year
Select
GNM
BSc N.
MSc N.
PBBSc
Test1
SCHOOL OR COLLEGE
NA
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Personal details
First Name
*
Max. 50 characters
Middle Name
Last Name
*
Max. 50 characters
Gender
*
Date Of Birth
*
Quota
*
Blood Group
Boy
Girl
General
Not Applicable
OBC
SC
ST
Place Of Birth
*
Age
*
Nationalty
*
Mother Tongue
Religion
Caste
Select
bangali
chhatishgarhi
ENGLISH
Gujrati
HINDI
MARATHI
PUNJABI
Christian
Hindu
Muslim
Shikh
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BHANIYA
BRAHAMAN
KURMI
MARWADI
SINDHI
Parent details
Father's First Name
*
Middle Name
Last Name
*
Father's Occupation Type
*
Father's Annual Income
*
Father's Mobile No.
*
Government
Private
Business
Mother's First Name
Middle Name
Last Name
Mother's Occupation Type
House Wife
Government
Private
Business
Details of Qualification Acquired
Class 10
TH
Name of the Board/University
Subject
Year of Passing
Percentage
Class 12
TH
Name of the Board/University
Subject
Year of Passing
Percentage
B.Sc. Nursing
Name of the Board/University
Subject
Year of Passing
Percentage
GNM
Name of the Board/University
Subject
Year of Passing
Percentage
P.B.B.Sc.
Name of the Board/University
Subject
Year of Passing
Percentage
Other Degree
Name of the Board/University
Subject
Year of Passing
Percentage
Years of experience after B.Sc. Nursing (applicable for M.Sc. Nursing candidate only)
Local Guardian Detail (if applicable)
Local Guardian
Profession
Office Address
Mobile No.
Other details
Aadhar Card NO.
Are you a Domicle of Chhattisgarh
How do you come to know about SSCN?
Yes
No
News Paper
Friends
Other Student
Other
Extra Curricular Activities interested in:
Ambition of Life :
Band
Rover & Ranger
Sport
Other Activities
Contact details
Land Line No.
*
Student Mobile No.
*
Student Email
Parents Mob.
*
Local Address
*
Father's Permanent Address
*
Pin Code
State
*
City
*
Country
Select State
Andaman & nicobar islands (A.N)
Andhra Pradesh (A.P)
Arunachal Pradesh (A.R)
Assam (A.S)
Bihar (B.R)
Chandigarh (C.H)
Chhattisgarh (C.G)
Daman & diu (D.N)
Delhi (D.L)
Goa (G.A)
Gujarat (G.J)
Haryana (H.R)
Himachal Pradesh (H.P)
Jammu & kashmir (J.K)
Jharkhand (JH)
Karnataka (KR)
Kerala (KL)
Madhya Pradesh (MP)
Maharashtra (MH)
Manipur (MN)
Meghalaya (ML)
Mizoram (MZ)
Nagaland (NL)
Orissa (OR)
Pondicherry (PY)
Punjab (PB)
Rajasthan (RJ)
Sikkim (SK)
Tamil Nadu (TN)
Tripura (TR)
Uttar Pradesh (UP)
Uttarakhand (UK)
West Bengal (WB)
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INDIA
Undertaking
