Homi Bhabha National Institute

An Aided institution of Department of Atomic Energy and a Deemed to be University under section 3 of the UGC Act.
nd
Regd. Office: 2 Floor, Training School Complex, Anushaktinagar, Mumbai 400 094

Enrolment Form for Admission to M.Sc./ M.Sc. (Nursing) /

M.Sc. (Clinical Research) / Int. M.Sc. Programme

Year 20…..-- 20….. Affix Recent self

attested
photograph
3.5 x 2.5 cm
Please sign
across

a. Application No(To be filled by CI) Enrolment No(To be allotted by HBNI)

A P

b. Constituent Institution(CI) Name / Off Campus Centre (OCC) Name:

I desire to enroll in HBNI as a regular student to the______________________programme. My details are

as follows:

1. Full Name (as per last Qualifying Degree)

(It is mandatory to write name in Hindi also)

2. Aadhaar Card No. (Self attested copy of the card
to be attached)
3. Date of Birth (DD/MM/YYYY)

4. Father/ Mother’s Full Name

5. Address for Correspondence

6. Permanent Address

7. Telephone & Mobile No.

8. Email-ID

9. Category (General/ SC/ ST/ Others(specify))

10. Nationality

11. Male/ Female/Transgender

12. Whether Physically/ Visually Challenged
(Yes/No, if Yes give details)
13. Educational Qualifications(starting with graduation degree)

Sr.No Degree Year % Marks Subjects University

1.

2.

3.

4.

Enrolment Form: M.Sc / M.Sc.(Nursing) / M.Sc (Clinical Research)/ Int. M.Sc Programme 1/2
 Certified that I am not enrolled in any other Programme of any University. The above information furnished by me is
true and correct. If any information is found to be incorrect or false, I understand that my admission shall be liable to
be summarily terminated without notice.

Date: Signature of the Student

Recommendation by the Designated Authority

Certified that the entries made by the student have been verified from the documents submitted. He/she is eligible
for admission to the programme mentioned below as per the relevant ordinance of HBNI.

The said student is recommended for admission in Programme…………………………………….

Date: Signature of Designated Authority with stamp

Verified the application for enrollment and found to be complete with all enclosures.

Date: Dean-Academic (Health Sciences), CI

To: Dean, HBNI

CHECK-LIST OF MANDATORY ENCLOSURES FOR APPLICANT

The fee (as applicable) to be paid in the form of crossed DD drawn in favour of: “Accounts Officer, HBNI”.
DD No. Date Drawn on Bank Branch Amount (Rs.)

Self attested Photocopies of all Mark Sheets, Degree Certificates and Proof of Date of Birth.

Enrolment Form: M.Sc / M.Sc.(Nursing) / M.Sc (Clinical Research)/ Int. M.Sc Programme 2/2