Liver Foundation, West Bengal

aspire to take science to society

Chandrakant Institute of Nursing and Health Sciences

Application Form For G.N.M Nursing : 2020-2021

Note: * Fields Are Mandatory

Academic Year
Full Name of Student *

(As per H.S.C/Equi.Exam Certificate)

Full Name of Father *

(As per H.S.C/Equi.Exam Certificate)

Occupation Of Father *
Date of Birth (DD/MM/YYYY) *
Category *
Gender *
Nationality *
Religion *
Marital Status *
Contact No(Mob) *
Aadhar No *
GNM
Education Qualification *
Name of Guardian
Occupation Of Guardian
Relationahip with Candidate
E-Mail Id *

Are You a Domicile / Permanent Resident West Bengal?

(Present / Correspondence Address)
Address
Pin
District
Post Office
Police Station
(Permanent Address)
Address
Pin
District
Post Office
Police Station
(10th / Equivalent)
Name Of Board
Full Mark
Mark Secured
% Of Mark Secured
Admit card of class 10th to be uploaded
(+2 / Equivalent)
Subject Full Marks Obtained Marks
1st Language
2nd Language
Best Three Elective Subjects
1st Elective
2nd Elective
3rd Elective
English Minimum 50%
Subject Full Marks Obtained Marks
English
Aggregate (1st Language+2nd Language+1st Elective+2nd Elective+3rd Elective)
Full Marks Obtained Marks Percentage
(English+1st Elective+2nd Elective+3rd Elective)
Full Marks Obtained Marks Percentage
Photo *
Signature *