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Admission Form 2024-25

For GNM admission

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DNYANESHWAR BIRADAR
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64 views7 pages

Admission Form 2024-25

For GNM admission

Uploaded by

DNYANESHWAR BIRADAR
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Govt.

College of Nursing
S.G.G.S . GOVT. NURSING TRAINING CENTER , CIVIL HOSPITAL NANDED , Nanded
Ref. No. Dr.SCGMCN/SS/CET/BSc.Adm./ /2023
Document Holding Certificate
Received all Original Documents From……………………………………………………………………………………For 1st year ANM/GNM/
admission through MH-Nursing-CET 2024 entrance exam in………………………………….Under
Quota/State Quota/GOI Quota (2024-25) as follows:
Sr. Original Documents list of Student Available YES/NO
no. Certificates Submitted (Original Set +2 Sets of Xerox copies duly self-attested)

01 Photo Identity Proof (Aadhaar Card)


02 Voter ID OR ANNEXURE-C
03 Nationality and Domicile Certificate/Valid Indian Passport
04 S.S.C. Passing certificate (Date of Birth Proof)
05 H.S.C Mark sheet
06 Admit Card of MH-B.Sc Nursing-CET 2023
07 MH-B.Sc Nursing-CET 2023 Mark sheet
08 Selection Letter AIEE/GOI
09 Cast certificate
10 Cast Validity certificate
11 Non-creamy layer certificate up to 31/03/2024 (For VJ,NT-1,2,3 and OBC,SBC)
12 College Leaving Certificate (LC/TC)
13 Physical Fitness Certificate
14 Migration Certificate
15 Gap certificate.
16 Defense Certificate (Certificate from Zillah Sainik Board Domicile Certificate of Parent
(D-1 and D-2)
Transfer Order of Parent for D-3
17 Person with Disability Certificate
18 EWS Certificate
19 Hilly Area Certificate, Domicile Cert. of Parent, School Cert.
20 Undertaking Form / Joint Undertaking
21 Income Certificate
22 DD No. Name of bank Amount Date Remark Yes/No

Note: Keep The All Original Documents Clearly Scanned in PDF File Format (Size: Up to 500Kb) In Pen Drive (With proper
Name) And Submit This Pen Drive in College at The Time of Admission Process for Eligibility purpose.

Principal
Govt. Nursing Training Center,
Nanded
FORM-B
For Detailed Information of Candidates

Latest
COLLEGE ROLL NO.___________________ Photograph
Govt. Nursing Training center S.G.G.S.M.Hospital
Station Road, Vazirabad Nanded- pin-431601.
ADMISSION TO FIRST Year ANM/GNM Nursing COURSE FOR ACADMIEC YEAR 2024-25.

A) NAME OF THE CANDIDATE Shri/Ku.: ________________________________


EMAIL ID:________________________________(Mob.NO.) ________________
AADHAR NO: ______________________ VOTER ID NO: __________________

B) FATHER’S NAME: Shri__________________________________________


EMAIL ID:_______________________________(Mob.NO.) _________________
C) MOTHER’S NAME: Smt. __________________________________________
EMAIL ID:________________________________(Mob.NO.) ________________
D) Permanent Address: _________________________________________
_______________________________________________________________
PIN CODE: _____________________ Domicile State: __________________
Address for Correspondence: __________________________________
_______________________________________________________________
_______________________________________PIN CODE: _______________
E) DATE OF BIRTH :___/___/_______ PLACE OF BIRTH :_______________
TALUKA :___________ DISTRICT : ___________ STATE:__________________
F) MOTHER TONGUE :______________________
G) CASTE : ______________ CATEGORY :____________RELIGION :___________
H) COLLEGE FROM WHICH H.S.C. PASSED : _________________________________
ADDRESS OF COLLEGE: ________________________________________________
HSC PASSING YEAR_________& MONTH: ___________

I) MH- ANM/GNM Nursing–CET 2023 Application Form No. :____________________


J) MH- ANM/GNM Nursing–CET ROLL NO. : ________________________
K) MH- ANM/GNM Nursing–CET MARKS :____/100 MH-RANK : __________

L) DATE OF COUNSELING BY DHS :_________________


M) QUOTA ALLOTTED ( State, Def, PH,HA,GOI.) :______________

N) H.S.C. AGGREGATE MARKS : ____AND %____ TOTAL PCB _____AND %____

And TOTAL PCBE ______AND %_______


Physics : ____________ Chemistry : ___________ Biology : ____________

Marks (Applicable) :Eng : _________ / Urdu : _________

O) Awards : ______________________________

P) Scholarship : ___________________________

Q) Sports (If represented state / District) :

Name &Year : _________________________________


Note: - Give The Three Latest Passport size photo with This from.

PARENT’S SIGNATURE STUDENT’S SIGNATURE

Principal
VERIFYING OFFICER Govt. College Of Nursing
Nanded.
Application For Admission

Name: -………………………………………………………………..

Address: -………………………………………………………………

Mobile No. Student : -………………………………………………..


Latest
E-mail Address of Student: -……………………………………….. Photograph

Mobile No. Parent :-…………………………………………………


Date: :- / /2024

To,
The Principal,
Govt. Nursing Training Center,
SGGSM Hospital Nanded.

Sub: - Joining ANM/GNM. Nursing Course at Govt. Nursing Training Center,


SGGSM Hospital Nanded

Respected/Sir,

I the undersigned Shri. /Kum……………………………………………………..


has been selected for ANM/GNM Course at Govt. Nursing Training Center,SGGSM Hospital Nanded
as per the Selection letter
of State list.

Kindly enroll me in your college as Is ANM/GNM Course Nursing student for Academic Year
2024-2025.

Thanking you.
Yours faithfully,

Signature of candidate

(Name:______________________________)
APPLICANT: __________________________________
__________________________________
__________________________________

Date: / /2024.

To,
The Principal,
Govt. Nursing Training Center,
SGGSM Hospital Nanded.

Subject: Regarding Non-Submission of Original Certificates.

Respected sir/Madam,

I am selected for admission to ANM/GNM Course Nursing Course in the year 2024-2025 at
Govt Govt. Nursing Training Center,SGGSM Hospital Nanded
I have not brought the following original certificates: -

1) ______________________
2) ______________________
3) ______________________
4) ______________________

I hereby assure to submit the above mentioned certificates within aperiod of 15 days from the date of
admission otherwise, my admission for ANM/GNM Nursing course will be cancelled. Therefore, kindly admit
me provisionally and oblige.
Thanking you.

Yours sincerely,

Place - Nanded.
Dated: / / 2024.
JOINT UNDERTAKING
(For All Newly Admitted Students)

Name of the Student: __________________________________

Roll No.: ________________

Govt Govt. Nursing Training Center,SGGSM Hospital Nanded

We have read Maharashtra Provision of Anti Ragging act 1999 (Maharashtra XXI III of 1999) and relevant
instructions against ragging. We are well aware of punishment under this act. If my son / daughter / myself have been
found guilty, he shall be punished for appropriate action under the act including imprisonment for a term which may
extend to two years with Fine Up to Rs 10,000/- (Rs Ten Thousand only) or dismissal from the institute and suspension of
student for various periods during inquiry period.

I am also aware of the fact that it will be mandatory for the institute to file First Information Report (FIR) to Local
Police Authorities in case Victim of ragging or his / her parents / Guardian is not satisfied with the action taken by the
Head of the institution or where head of the institution is of the opinion that the incident ought to be reported.

Place : Nanded Name & Signature of Student

Date: ____/_____/2024

Name & Signature of Parent

Signature
Member Secretary Signature
Anti Ragging Comitee
Principal, Govt. College Of Nursing

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