APPLICATION FOR ADMISSION TO H.M. R. SCHOOL OF NURSING
Name of the Canidate (In Block Letters) :
Name of the Father / Guardian :
Occupation of the Parent / Guardian :
Annual Income of the parent / Guardian :
Date of Birth and Place of Birth
(In Figures and words) :
Sex :
Male
Female
Martial Status :
Whether the Candidate belongs to Karnataka / Non Karnataka ( Mention State ) :
Nationality, Religion & Caste :
Whether the Candidate belongs to
(Certificate Should be enclosed ) :
S.C.
S. T.
Group A
Group B
Group C
Group D
Group E
Handicapped
General
Mother Tongue :
Highest Examination Passed :
Medium of Instruction in PUC / PDC :
Give details of passing PUC / PDC
or Equivalent examination :
Reg. No
Month & Year
Maximum Marks
Marks obtained
Percentages
Address :
Permanent Address :
Correspondent Address :
