Al shifa college of nursing

Name of the Applicant

Expansion of Initial(s)

Age

Date of Birth

Sex MaleFemale

Religion

Caste

Name of the Parent/Guardian/Spouse

Occupation of the Parent/Guardian/Spouse

Annual Income

Nationality

E-mail

Mobile/Telephone

Marital Status (Whether Married/Unmarried/ Divorced/ Widow)

Whether in service or not

Address for Communication

Permanent Address

Address of the Parent/Guardian/Spouse

Are you phisically Handicaped YesNo

Do you need Hostel Accommodation YesNo

Details of the Qualifying Examination

Reg .No./Month/Year

School/College

Subject wise marks of S.S.L.C *

Subject

Maximum Marks

Marks Obtained

% of Marks

Physics

Chemistry

Biology

Total

Subject wise marks of +2*