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St. Stephen's Hospital College of Nursing

Tis Hazari, Delhi - 110 054
An ISO 9001, ISO 14001, ISO 45001 and
NABH Pre‑accreditation Entry Level - Hospital (PEH) Certified Hospital
Laboratory Diagnostic Services accredited by NABL (Certificate No. MC-2570)
Tel.: 23957977, 23958005, 23977930, 23982978, 23983580, 23983573 - 74, 23966021 - 27 (Ext- 677)
Fax: 23932412, E-mail : mail@sshcon.com, Website : www.sshcon.com
Application Form for Admission to the GNM Course, 2024

Registration Number: SSHCON/2024/O-6

Application Form for Admission To GNM Course, 2024

1. Name in Full:* HARSHITA RAWAT

2. Father's Name* DAN SINGH RAWAT

3. Address* KH. NO.-31/16, B-BLOCK, GALI NO.-44/5, KAUSHIK ENCLAVE, BURARI, DELHI-110084

4. Local Guardian Address

5. Mobile Number* 9560857150 6. Alternate Mobile Number 9560836551

7. Date of Birth* : 01-09-2005 8. Gender : Female

9. Height ( in CM )* 157 10. Nationality* INDIAN

11. Religion : Hinduism 12. Email: diwanrawat85@gmail.com

13. Educational Qualification:

Sl.no. Name & Address of the Examination Appeared Board / % Year of No. of Attempts in Attachment
School / College last and Passed 10th & 12th University Passing 10th & 12th Class
attended

1 Sarvodaya Kanya 12th CBSE 73 2023 1 

Vidyalaya Burari Delhi (certificate/105941450_1714407099.pdf)

2 Govt. Girls Sr. Sec. 10th CBSE 89 2021 1 

School Nathupura Delhi (certificate/103732370_1714463368.pdf)

14. Payment Details

Payment Mode Transaction Date: Payment Ref. No. Pay Status

card 30-04-2024 13:23:37 pay_O4l4egh7lfDcAU captured

15. Certification and Acceptance:

; I declare that the qualification details submitted by me are true to the best of my knowldege.Any deviation found at later stage will lead to cancellation of my
candidature to the applied course. I have read and agreed with the terms and conditions ()

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