Application form

Application Fees

Payment reference number *

Personal Information

Name (as given in Std . X certificate)*

Father's / Guardian's Name *

Mother's Name *

Gender : Male Female

Date of Birth (Attach photo copy of the Std . X marks sheet for age proof)*

Nationality : Indian Foreign

Religion*

Community

Marital Status : Single Maried

Mother Tongue *

Physically Handicapped : Yes No

Contact Information

Postal Address for Communication *

Permanent Address *

State

Pin Code

Country

Communication Address and Permanent Address are same (Optional)

Email

Phone Number

Educational Information

Qualification {{n+1}}

Exam Passed

Register Number

Month & Year of Passing

Name & Address of the School / College

University/Board

Overall%

Class / Division

Cut-off Mark

Physics *

Chemistry *

Maths *

Biology *

Document Upload

10th Mark Sheet

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12th Mark Sheet

Choose file

Photo

Choose file

Transfer Certificate (Optional)

Choose file

Community Certificate

Choose file

Nativity Certificate (Optional)

Choose file

First Graduate Certificate (Optional)

Choose file

Srilankan Tamil Refugee Certificate (Optional)

Choose file

Declaration

I hereby declare that the particulars given in the application form are true to the best of my knowledge and belief. I understand and agree that in case any information furnished is proved to be false or incorrect, my admission is liable for immediate cancellation, forfeiture of the fees paid by me and also any action the management might choose to pursue. I undertake to complete the course and in the event of discontinuation, I will pay the fee for the entire duration of the course. I also agree to abide by the rules and regulations of the institution at all times. Admissions are made at the absolute discretion of the management and any dispute whatsoever would be subject to the jurisdiction of courts at Chennai only.

INDIRA SCHOOL OF NURSING

Application Form for Diploma course in General Nursing & Midwifery (3½ Years)