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
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:[email protected]
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
