CHOITHRAM COLLEGE OF NURSING

CHOITHRAM HOSPITAL & RESEARCH CENTER CAMPUS,

MANIKBAGH ROAD, INDORE- 452014, (M.P.)

ADMISSION FORM
Photo
Tick (✓) the course of study you wish to pursue
1. B.Sc. Nursing □
2. M.Sc. Nursing □
S.No Particulars Details

Name of the candidate in full (block letter to be

1. entered as found in the certificate of the qualifying
examination).

2. Father / Husband Name & Occupation

3. Mother Name & Occupation

4. Present address of the candidate with phone no.

5. Permanent address with phone no.

6. Whether you belong to Schedule caste /

Schedule Tribe / Backward class / General
7. Religion
8. Annual Income of Father / Mother

9. Date of birth (in Christian era)

10. State of Domicile

11. Mother Tongue
12. Languages Known (Read, Write, and Speak)
13. Nationality

Points to Remember
• Download the form
• Make a folder of your name and place every scanned copies of your document and form into it
• Mail the folder at cconursing@yahoo.co.in
• Admission form fee for :
*B.Sc. Nursing - Rs 600
*M.Sc. Nursing -Rs 1000
*It should be paid at the time of submission of hard copies in the college.
 14. Give below particulars of all academic and other examinations passed.
Examination School / College Year of Board / Total Marks Total
Passing University Marks Obtained %
10th (High School)
12th (Higher Sec.)
B.Sc. (N) 4thyear/
PBBSC (N)2nd year

15. To be filled up from 12th or (10+2) mark sheet

Subject Marks. (TOTAL) Marks Obtained
Physics
Total Marks: ……………..
Chemistry
Biology Total % ………………..
English
Total

16. Details of attested enclosures photo copy to be attached to the admission form.
Bring original documents at the time of interview. Tick (✓) the ones attached
a) Degree/Diploma certificates □ b) 10th Mark sheet □ c) 12th Mark sheet □
d) Medical fitness certificate □ e) Domicile certificate □ f) 8 Passport size photos □
g) Migration certificate □ h) Cast certificate □ i) Income tax certificate □
(if other state or CBSE)

j) Aadhaar Card □ k) Transfer certificate (TC) □ l) Gap Certificate (if) □

Ground Rules of the Institution

• Students have to be respectful in attitude and manner towards people and property of the campus.
• Student must strive to show 100% attendance in theory and clinical.
• Students are expected to pay fees and other dues on the scheduled date.
• Students must abide rules and regulations of the college, hostel and campus.
• Students must attend and participate in all academic programs, co-curricular activities, functions
and other Institution related programs.
• Maintain highest standards of cleanliness at all times in the campus.

Signature of Applicant Signature of Parent

Date: Place: