Registration Form Apply

Academy Information

Course Applied for Registration *

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 *

Aadhar No *

Primary Mobile No *

Secondary Mobile No

Nationality *

State *

District *

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 *

Training Period (In Year) *

Date From *

Date To *

Documents (Required)

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

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

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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)*

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College Verification Letter (Max file size of document 2 MB only)*

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Photo

Select Photo Change Remove

(Max file size of Photo 1 MB only)