Sr.No.
: Admission Form Academic Year
Course Selected by Student :_____________________________________________________________
G.N.M. COURSE (CODE-) ASNA BASIC B.Sc. NURSING (CODE-) ASNA
A.N.M. COURSE POST BASIC B.Sc. NURSING PHOTO
Respected Sir/Madam
I, here the undersigned want to take admission at your college/school in Programme stated
above, I hereby furnished the necessary particular as under.
STUDENT’S DETAILS:
Name :
Mobile No.:
Date of Birth :
Correspondence Address :___________________________________________________________________________
______________________________________________________________________________________________
Permanent Address :_______________________________________________________________________________
________________________________________________________________________________________________
City/Village :___________________ State :_______________________ Pincode : _____________________________
Aadhar Card Number :____________________________________________________________________________
Category : ____________________ Religion :__________________ Caste : _________________________________
Gender :_______________________ Blood Group :__________________
Email ID :_______________________________________________________________________________________
PARENTS/GUARDIAN DETAILS :
Name :
Mobile No.:
Relation with the Students __________________________________________________________________________
STUDENTS DETAIL :
Qualifying Board or Year of Seat Number ACPC Rank Mark Percentge %
Examination University Passing Obtained
SSC
HSC
GUJCET/NEET
DEGREE
(P.T.O.
FEE STRUCTURE :
Sr. Programme Tuition Hostel Transportation Uniforms/ Library and Development
No. Fees Fees Miscellaneous Exmination Fees
Fees
1 B.Sc. (N)
2 P.B.B.Sc. (N)
3 G.N.M.
4 A.N.M.
DOCUMENTS CHECK LIST FOR STUDENTS
Sr. PARTICULARS Y/S
No.
1. S.S.C. Mark Sheet (10th) + Credit Certificate (Original)
2. H.S.C. Mark Sheet (12th) + Credit Certificate (Original)
3. School Leaving Certificate / Transfer Certificate (Original)
4. Trial / Attempt Certificate (Original)
5. Caste Certificate (SC, ST And SEBC) Issue by State Government (Original)
6. A Copy of Income Certificate (Original)
7. Non Creamy layer Certificate of the Family, Valid as per State Government (Original)
8. Certificate of Physical Disability, Issue by the Civil Surgeon/Competent Medical (Original)
Authority, in Case the Student is Physically Handicapped.
9. A Copy of Valid Certificate of Income Issued by Authority Empowered by the State Government
Applicable.
10. 8 Passport Size Photographs of Students
11. A Copy of Aadhar Card – To be linked (Xerox)
12. Passbook and Cheque (Xerox)
13. Pan Card Xerox (Original)
ADDMISSION DETAILS :
Mentioned the Quota admission (SQ/MQ/VQ) :_______________________________________________________
(SQ: State Quota, MQ: Management Quota, VQ: Vacant Quota)
Date of Admission _________________________ (DD/MM/YY)
DECLARATION BY STUDENT:
1. I hereby, declare that, the details given by me in the Admission form are complete and true to the best of my
knowledge and based on records.
2. I hereby, undertake to present the original document immediately upon demand by the concerned authorities of the
ASON, follows the code of conduct prescribed for the students of ASON.
3. I hereby, promise to bide by the admissible rules and regulations, concerning discipline, attendance etc. of ASON
and also to follow the code of conduct prescribed for the students of ASON.
4. I understand that 85% attendance in theory and 100% attendance in practical is compulsory. In case my attendance
falls shorts, for any reason, the competent authority of the institute may take such punitive action against me, as may
be deemed fit and proper.
5. I, hereby declare that, I will neither join any coercive/strike for the purpose off forcing the authorities of ASON, to
solve the problems, I will participate in activity which has a tendency to disturb the peace of the institute and its
hosted premises.
6. Any kind of cancellation will not be accepted after confirmation of the admission. If during Admission
withdraw/dismiss admission by the student than has to pay reasonable All Expenses.
____________________ _________________________ _______________________
Student’s Sign Parent’s Sign Authority Sign
Place : _________________
