Academy Information

ApplicationFor *

Select NURSE MIDWIFE B.SC. A.N.M

Course Applied for Registration *

Select Fees Type ANM GNM/BSC Nursing

Personal Information

Name Mr./Mrs. *
(As per 10th class mark sheet)

Father Name *
(As per 10th class mark sheet)
(Don't write Shri/ Mr.)

Date Of Birth *
(As per 10th class mark sheet)

Age *

Birth Place (District, State)*

Gender *

--Select-- Male Female

Aadhar No *

Email

Primary Mobile No *

Secondary Mobile No

Nationality *

State *

-Select State- Andaman and Nicobar Island Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Dadra and Nagar Haveli Daman and Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Puducherry Punjab Rajasthan Sikkim Tamil Nadu Telangana Tripura Uttar Pradesh Uttarakhand West Bengal

District *

--Select--

Tehsil *

Pincode *

Permanent Address *
Please input the correct address Because the certificate will be sent by India Post to this address

Current Address *

Nursing School/College Name *

Parentel Council *

-Select State- Andaman and Nicobar Island Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Dadra and Nagar Haveli Daman and Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Puducherry Punjab Sikkim Tamil Nadu Telangana Tripura Uttar Pradesh Uttarakhand West Bengal

Registration No *

Reg Date *

Training Period (In Year) *

--Select-- 1.5 2 3 3.5 4

Date From *

Date To *

Examination Body *

Parent Council *

Parent Council Reg *

Documents (Required)

Secondary Marksheet(Original Scan Copy) (Max file size of document 2 MB only)*

 

Select Pdf Only Change Remove

Senior Secondary Marksheet(Original Scan Copy) (Max file size of document 2 MB only)*

 

Select Pdf Only Change Remove

Marksheet of GNM/ANM/Bsc Nursing(Original Scan Copy) All marksheet will be attetched in single file otherwise your application rejected
(Max file size of document 5 MB only)*

 

Select Pdf Only Change Remove

Aadhar Card(Original Scan Copy) (Max file size of document 2 MB only)*

 

Select Pdf Only Change Remove

Registration Certificate(Original Scan Copy) (Max file size of document 2 MB only)*

 

Select Pdf Only Change Remove

Last Degree / Diploma Certificate(Original Scan Copy) (Max file size of document 2 MB only)*

 

Select Pdf Only Change Remove

Photo

Select Photo Change Remove

(Max file size of Photo 1 MB only)

Fee Information

Fee Amount :

0