Registration Form – Mata Padmawati College of Nursing

Provisional Registration Form

Provisional Registration Form for Nursing Programme (Only Female)

(Academic Session 2023-2024)

Instructions

It is to be noted that the provisional registration will be converted to confirmed admission only after fulfillment of admission norms of INC, New Delhi, DME Shimla, HP University, Atal Medical and Research University, Mandi & HPNRC Shimla
The admission will be confirmed after the fulfillment of MPCN Admission criteria with relevant documentation after lifting of lockdown situation

Course Preferred

Name of the Candidate

Date of Birth

Age in years as on 31st August 2020

Category

Marital Status

Nationality

Hostler/Day-Scholar

Father’s Name

Father’s Contact No

Whatsapp Contact No

Mother’s Name

Mother’s Contact No

Whatsapp Contact No

Permanent Address

Correspondence address

Email ID

10th - Name of Board/ University

Percentage in 10th class

12th - Name of Board/ University

12th -Stream (Science,Arts /Humanities,Commerce etc)

Percentage in 12th class

GNM-Name of Board/University

1st year GNM - Marks obtained

1st year GNM - Percentage

2nd year GNM - Marks obtained

2nd year GNM - Percentage

3rd year GNM - Marks obtained

3rd year GNM - Percentage

Passport size photograph

Matric certificate

10+2 result proof

GNM Recent results detailed mark card

I solemnly affirm that the information provided in this form is true & correct to the best of my knowledge. in case any information is found is to be false; I will not raise any objection if the admission is summarily rejected or cancelled by the authority.
If the admission get confirm I hereby undertake to abide by all the conditions, rules and regulations in force at present and also those which may hereafter be introduced for the administration of the College. I will do nothing unworthy to the student of the college either inside, outside or anything that will interfere with its orderly working and discipline. I am aware that the management has the full authority to expel me for misbehavior, continuous failures, found guilty of ragging and for any other valid reasons.

Course Preferred
Name of the Candidate
Date
Date Format: DD dash MM dash YYYY
Age in years as on 31st August 2020
Category
Marital Status
Nationality
Hostler/Day-Scholar
Father’s Name
Father’s Contact No
Whatsapp Contact No
Mother’s Name
Mother’s Contact No
Whatsapp Contact No
Permanent Address
Correspondence address
Email ID
10th - Name of Board/ University
Percentage in 10th class
12th - Name of Board/ University
12th -Stream (Science,Arts /Humanities,Commerce etc)
Percentage in 12th class
GNM-Name of Board/University
1st year GNM - Marks obtained
1st year GNM - Percentage
2nd year GNM - Marks obtained
2nd year GNM - Percentage
3rd year GNM - Marks obtained
3rd year GNM - Percentage
Passport size photograph
Matric certificate
10+2 result proof
GNM Recent results detailed mark card
Consent
I solemnly affirm that the information provided in this form is true & correct to the best of my knowledge. in case any information is found is to be false; I will not raise any objection if the admission is summarily rejected or cancelled by the authority.
If the admission get confirm I hereby undertake to abide by all the conditions, rules and regulations in force at present and also those which may hereafter be introduced for the administration of the College. I will do nothing unworthy to the student of the college either inside, outside or anything that will interfere with its orderly working and discipline. I am aware that the management has the full authority to expel me for misbehavior, continuous failures, found guilty of ragging and for any other valid reasons.

Provisional Registration Form

Provisional Registration Form for Nursing Programme (Only Female)

(Academic Session 2023-2024)

Instructions

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