Fill Up and Print Admission Form

Printed Admission Form Must Be Submitted To The Institute
With Recent Passport Size Photograph Attached and Duly Signed

APPLICATION FORM

To,

The Principal

Rajib Gandhi Nursing Training School

167, Badamtala, P.O. Fingepara

P.S. Bhatpara, Dist. - North 24 Parganas

Kankinara, Pin - 743129, West Bengal

PLACE YOUR
PHOTO HERE

(TO BE FILLED IN BLOCK LETTERS ONLY)

Name of the Candidate (As per Madhyamik Certificate):

Date of Birth & Age:

Religion:

Nationality:

Marital Status: Married Unmarried

Permanent Address:

P.O.:

P.S.:

Pin Code:

Mobile No.:

E-mail:

Father's Name:

Occupation:

Educational Qualification:

Family Income:

Office Address:

Mobile No.:

E-mail:

Mother's Name:

Occupation:

Educational Qualification:

Address:

Mobile No.:

E-mail:

Any health Problem (Chronic or recurrent):

SC, ST, OBC Candidates must submit supporting documents: General SC ST OBC

Name of Local guardian:

Relationship:

Address:

Mobile No.:

Name of Selected / approved Visitors (any two visitors):

(The photographs of the persons to be produced later on)

(a)

(b)

Educational Qualifications:

Degree	Diploma	Year	Subject	Board	Institute

Extra Curricular activities (if any):

Full Signature of : Candidate

Father

Mother

Guardian

I am Ms. / Mr.

D/o / S/o

Declaring that above mention information's are true.

Full Signature of the Candidate with date