St. Joseph’s College of Nursing Regd. No.

Nallapadu – 522 005. Guntur – Dt. (A.P)

APPLICATION FOR B.Sc.

AFFIX YOUR
LATEST
PHOTOGRAPH
NURSING ADMISSION
B.Sc. NURSING
Last date of issuing the application: 31st July, 2022

Name of the Candidate: …………………………………………………….

(In block letters as found in 12th class certificate)

1. Name of the Father: ……………………………………………………………………….

2. Name of the Mother: ………………………………………………………………………

3. Date of Birth:………………… Age: ……………. Year:……………….

4. Cast : ………………………………………. Religion :…………………………………..

5. Address: ………………………………………………………………………...................

………………………………………………………………………………………………

6. Present Address : …………………………………………………………………………...

………………………………………………………………………………………………

Ph. No. : ………………………….. E-mail:………………………………………………

7. Name of the Father / Guardian: …………………………………………………………...

8. Student Aadhar Card No.:…………………………………………………………………..

9. Intermediate / PUC/HSC/ 12th Standard Marks: Maximum marks: ………………………

Marks obtained:…………… Total Percentage: …………… Group Percentage:………...

10. Attach copies of the following certificates and handover directly or by post with filled application so as to
reach us on or before……….
i. Intermediate /PUC/HSC/12th Standard certificate
ii. 10th class certificate
iii. Migration certificate (candidates from other states)
iv. Study certificate (VI to XII)
v. Transfer certificate
vi. Conduct certificate
vii. Student, Father & Mother Aadhar Cards
viii. Medical certificate
ix. Caste certificate
x. 10 copies of recent passport size photos
xii. Certificates of co-curricular activities /Sports/games (if any)
xiii. NEET exam qualified certificate
11. DECLARATION
 I hereby declare the above statement to be true and correct to the best of my knowledge.
 I undertake to abide by the rules and regulations of St. Joseph’s College of Nursing. Further, I consent to
undergo the course for its full duration or pay the amount fixed by the management, in the event of my
voluntary withdrawal or dismissal for any unsatisfactory conduct before completion of the training period.
I undertake that so long as I am a student of this institution and during my service I will do no harm, either
inside or outside the institution that will interfere with the orderly Governance and discipline.

NOTE: i. College fee once paid shall not be refunded under any circumstances.
ii. Advance paid for the conformation of seat will not be refunded in case of cancelling the admission.

Signature of Candidate Signature of Father/Guardian

Date: Date:

IMPORTANT INSTRUCTIONS

1. The application should be filled up in student’s own handwriting

2. Do not enclose original certificate along with the application (by post).
3. The filled Application form and required documents also be sent as attachment to following mail:
stjcon2003@gmail.com
4. Post the completed application to the Principal on or before 5th August 2022.
5. Last date of submitting the application 10th August, 2022.

FOR OFFICE USE ONLY