`.500/- charusat manikaka topawala institute of nursing · ¨hsc mark-sheet ¨birth certiicate...

Obstetric&GynaecologicalNursingMedicalSurgicalNursing ChildHealthNursing(Pediatric)

MentalHealthNursing(Psychiatric)CommunityHealthNursing

MANIKAKATOPAWALAINSTITUTEOFNURSINGAconstituent

CHAROTARUNIVERSITYOFSCIENCEANDTECHNOLOGYAegis:ShriCharotarMotiSattavisPatidarKelavaniMandal

AcademicYear:2020-21Ÿ AccreditedGrade“A”byNAAC

ApplicationFormforMasterofScienceinNursing(M.Sc.Nursing)

FormNo:

Percentage

FormFees: `.500/-

City-Dist.

6.RNRMNo:_____________________________________&ProgramDuration(AsperRNRMCerti�icate)________________________to________________________

7.WishtooptstudywithearnScheme:YesNo

FormNo:__________Date:________/________/__________

Name:___________________________________________________________ReceivedBy:_______________________

CHARUSATCHAROTARUNIVERSITYOFSCIENCEANDTECHNOLOGY

E-Mail

Mob. Mob.

DD/MM/YYYY DD/MM/YYYY

FormoreInformation:CHARUSATCampus,ChangaContact:PH.#+91-02697-265201Fax#+91-2697-265011/21Website:www.charusat.ac.inPh:+91-2697-265201/5211E-mail:principal.mtin@charusat.ac.in

DECLARATION

We, (“thecandidate”)__________________________________________________________________________________

and (“theguardian)” ___________________________________________________________________________________

herebysolemnlyundertakethat

DatePlaceSignatureofCandidateSignatureofGuardian

DocumentRequired:(Please()TickMark)

¨ FinalYearB.Sc.Nursing/PostBasicB.Sc.NursingMark-sheet¨ RegistrationCerti�icate¨ HSCMark-sheet¨ BirthCerti�icate¨ RelivingLetter¨ ExperienceLetter¨ AadharCardZerox

ü

± The information given above is true. If found false, we understand that theadmissiongrantedwillbecancelledandallfeesforfeited.

± Wehavereadtheadmissionguidelinecarefullyandagreetofollowthem.

± WeshallpaythefeeseveryyearasdecidedbytheManagementoftheInstitute.

± WewillabidebytherulesandregulationsformedbytheInstitute.

CHARUSATCHAROTARUNIVERSITYOFSCIENCEANDTECHNOLOGY