C.N.K.

SCHOOL & COLLEGE OF NURSING

(Approved by: Govt. of Karnataka, Recognized by: INC & KNC, Affiliated to RGUHS / KSDNEB)
#12, Cholanayakanahalli, RT Nagar Post, Hebbal, Bengaluru, Karnataka - 560032.
Website: www.cnkcon.in / E-mail: admission@cnkcon.in

APPLICATION FORM
Application No :
20 - 20
Course Affix
BSc Nursing PHOTO

PB BSc Nursing
GNM

Name of the Candidate :

(IN Block Letters )

Father’s Name :

Mother’s Name :

Permanent Address : Present Address :

Nationality : Pincode :

Land Phone : Mobile :

E-mail : Whatsapp :

Sex : Male Female Marital Status : Yes No

Age : Date of Birth :

Religious : Caste :

Blood Group : Mother Tongue :

(P.T.O)
 EDUCATIONAL QUALIFICATIONS

Educational Qualification Name of the Board Year of Passing No. of Attemps Total Marks Scored % (Percentage)

th
SSLC / 10

Plus Two / 12 th

GNM

Attested photocopies of the Certificates to be enclosed along with 6 Recent Passport Size Photographs

Items Yes/No Items Yes/No

th
1) 10 Certificate and Marks Sheet 7) Conduct Certificate
2) Plus Two Certificate and Marks Sheet 8) Migration Certificate
3) GNM Marks Sheet 9) Eligibility Certificate
4) GNM Diploma Certificate 10) Copy of Aadhaar Card
5) GNM Registration Certificate 11) Income Certificate
6) Transfer Certificate 12) Caste Certificate

Local Guardian’s Address .........................................................................................................................................................

...............................................................................................................................................................................................................

Phone : ......................................................................................... Mobile ......................................................................................

:

Declaration by the Candidate & Parent : We hereby declare that all the information provided
in the application form above id true to the best of our knowledge and belief.

Signature of the Parent / Guardian Signature of the Candidate

Date .:..............................
Place ................................
:

Fees and Other Considerations are to be paid through DD in favor of C.N.K. College / School of Nursing Payable at Bangalore.

(for Office use only)

Admitted : Yes /No.

Admitted No. :

(Signature of Admission Director) (Signature of the Principal)