1General Information

2Educational Information

3Upload Files

4Undertaking

J.L.N. INSTITUTE OF NURSING EDUCATION, TONK ROAD, SHIVDASPURA, JAIPUR

APPLICATION FOR ADMISSION

The Application form should be filled by the student along with the requisite fee & certified copies must be submitted to the College

Photo of the Applicant *

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Accepted file types are JPG/JPEG/PNG

Title of the Applicant *

First Name *

Middle

Last Name *

Father/Guardian’s First Name *

Father/Guardian’s Middle Name

Father/Guardian’s Last Name *

Mother /Guardian’s First Name *

Mother/Guardian’s Middle Name

Mother/Guardian’s Last Name *

Date of Birth *//

Sex *

MALE
FEMALE

Category *

GENERAL
SC
ST
OBC

Nationality *

Phone *

Email for correspondence *

Confirm Email

Address for correspondence

Street Address *

City *

State *

Postal Code *

Do you have Government Job? *

Upload Study Leave Certificate *

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Accepted file types are PDF/JPEG/JPG; Max file upload size is 1MB

Educational Qualification:

Xth Class

Name of Exam *

School Address *

Board/University *

Year of Passing *

Percentage *

XIIth Class

Name of Exam *

School Address *

Board/University *

Stream *

Year of Passing *

Percentage *

Whether Hostel facility required *

Xth class Mark sheet Upload *

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Accepted file types are PDF/JPEG/JPG; Max file upload size is 1MB

Xth class Certificate Upload *

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Accepted file types are PDF/JPEG/JPG; Max file upload size is 1MB

XIIth class Mark sheet Upload *

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Accepted file types are PDF/JPEG/JPG; Max file upload size is 1MB

XIIth class Certificate Upload *

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Bonafide Certificate Upload *

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Accepted file types are PDF/JPEG/JPG; Max file upload size is 1MB

Certificate for SC/ST/OBC Upload *

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Accepted file types are PDF/JPEG/JPG; Max file upload size is 1MB

Father/Mother/Guardian’s undertaking

Parent undertaking *

My Son/Daughter and is seeking admission with my consent and in the event of his/her being admitted to the college, I will be personally responsible for:

1. His/Her good conduct and behavior during his/her education at the College.

2. Return of books issued to him/her by the College.

3. Any other liability related to his/her education at the College/Institution Further, I undertake to pay his/her fees and other expenses at the College, and expenses on educational tour. I also agree that he/she shall abide by the rules of discipline of the College as laid down by the management.

First Name of Father/Mother/Guardian *

Middle Name of Father/Mother/Guardian

Last Name of Father/Mother/Guardian *

Signed Date by Father/Mother/Guardian *

Father/Mother/Guardian Phone *

Father/Mother/Guardian Email

Address of Father/Mother/Guardian

Street Address *

City *

State *

Postal Code *

Undertaking by the Applicant

Student undertaking *

I Agree that

1. I declare that I have not been debarred from joining any educational institutional institution or rusticated from the institution/University/Board last attended.

2. I declare that at the statements made in application by me are true to the best of my knowledge and belief. I clearly understand that if any of the statements is subsequently found untrue my admission to the college/institution would stand automatically cancelled.

3. I have read the prospectus and instruction incorporated carefully, I have read and minimum eligibility criteria and I have been provided with necessary information in this regard. In the event of any information being incorrect or misleading my candidature shall be liable to cancellation at any time and I shall not be entitled to refund any fee paid by me to the College.

4. I agree the terms & conditions regarding tuition fee/hostel fee and other charges according to Govt. & federation norms which is non-refundable.

5. I have satisfied myself that I fulfill the minimum educational, physical and medical standards and that I agree to be removed from the institution if found deficient in these standards during the course of my stay at the College.

6. I agree that admission may be granted to me on the conditions stated in the latest edition of the prospectus/ syllabus prescribed by the University or such modification there off as may be made by the authorities.

7. I have read the rules, regulations and code of conduct as prescribed by the College and promise to abide by them and those that may be made in future for the admission to the College, I also undertake that I shall do nothing inside or outside the College Campus that will interfere with its discipline.

8. I accept that if any of the above undertaking is misleading I agree to be prosecuted to the court of law for providing take acceptance.

9. All disputes would be subject to jurisdiction of courts at Jaipur only.

Date Signed *

Signature of the Applicant *

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Upload the scanned signature in JPEG/JPG/PNG/PDF format

Reference of at least two persons not related to you:

1st Reference First Name *

1st Reference Middle Name

1st Reference Last Name *

1st Reference Designation/Occupation *

1st Reference Telephone *

1st Reference Address

Street Address *

City *

State *

Postal Code *

2nd Reference First Name *

2nd Reference Middle Name

2nd Reference Last Name *

2nd Reference Designation/Occupation *

2nd Reference Telephone *

2nd Reference Address

Street Address *

City *

State *

Postal Code *

GENERAL NURSING & MIDWIFERY 2020 ADMISSION FORM

J.L.N. INSTITUTE OF NURSING EDUCATION, TONK ROAD, SHIVDASPURA, JAIPUR

APPLICATION FOR ADMISSION

Educational Qualification:

Xth Class

XIIth Class