Academy Information
Course Applied for Registration *
Personal Information
Name Mr./Mrs. *
(As per 10th class mark sheet)
Father Name *
(As per 10th class mark sheet)
(Don't write Shri/ Mr.)
Date Of Birth *
(As per 10th class mark sheet)
Age *
Birth Place (District, State)*
Gender *
Aadhar No *
Email
Primary Mobile No *
Secondary Mobile No
Nationality *
Permanent Address *
Please input the correct address with PIN code Because the certificate will be sent by India Post to this address
Current Address *
Nursing School/College Name *
Parentel Council *
Registration No *
Reg Date *
Training Period (In Year) *
Date From *
Date To *
Documents (Required)
Secondary Marksheet(Original Scan Copy) (Max file size of document 2 MB only)*
 
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Senior Secondary Marksheet(Original Scan Copy) (Max file size of document 2 MB only)*
 
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Marksheet of GNM/ANM/Bsc Nursing(Original Scan Copy) All marksheet will be attetched in single file otherwise your application rejected
(Max file size of document 5 MB only)*
 
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Aadhar Card(Original Scan Copy) (Max file size of document 2 MB only)*
 
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Registration Certificate(Original Scan Copy) (Max file size of document 2 MB only)*
 
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Last Degree / Diploma Certificate(Original Scan Copy) (Max file size of document 2 MB only)*
 
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Photo
Select Photo Change Remove
(Max file size of Photo 1 MB only)
Fee Information
Fee Amount :