Admission Application | Azeezia College of Nursing

Personal Information

Name of the Student *

Expansion of Initials *

Date of Birth *

Age

Gender *

Male Female

Category under Admission *

Admission Quota *

Religion *

Caste *

Blood Group *

Aadhar Number *

Mother Tongue *

Nativity *

Nationality *

Mobile No. of Student *

Email ID of Student *

Parent / Guardian Detail

Name of Parent / Guardian *

Occupation *

Contact No. *

Email ID

Address

Permanent Address *

Address for Communication

House Name *

Street *

Post *

District *

State *

Pin Code *

Tel. No. *

Qualifying Examination

Name of Qualifying Examination *

Name of School / College *

Name of Board / University *

Register No. *

Year *

Grade *

% of Marks in Subjects

Subject% of Marks

PCB (Physics, Chemistry, Biology)

Biology Alone

English

Mathematics Alone

Medical & Other Details

History of any Major Illness *

Physical Disability *

Yes No

Applied for Higher Options? *

Yes No

Extra-Curricular Activity *

I hereby declare that the information furnished in this application is true, complete and correct to the best of my knowledge and belief. I understand that if any information is found to be false or incorrect, my application or admission is liable to be cancelled. I consent to Azeezia College of Nursing using these details for processing my admission and for contacting me regarding it. *

Signature of the Applicant *

Upload Signature Sign on white paper and upload a clear photo / scan · JPG / PNG · Max 1MB

Application for Admission

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