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Application No:

Date:

Name (as per 10^th Mark Sheet) with initial:

Date of Birth (as per 10^th Mark Sheet) & Age:

Caste & Community:

Community Certificate No.:

Religion:

TC No.:

Nationality:

Mother Tongue:

Father's Name & Phone No:

Mother's Name & Phone No:

Student Contact No:

E-Mail ID (self):

Pan No.:

Aadhaar No.:

10th Marksheet:

12th Marksheet:

Aadhar Card:

Community Certificates:

DD (Rs. 500/-):

DD Payable at : ( MEENAKSHI COLLEGE OF NURSING, MADURAI.)

Address for Communication:

Door Number, Street Name:

Village/Taluk:

District:

Pin Code:

Extracurricular Activities:

Hobbies:

Register Number

Subjects

Marks

Total & Percentage of (Physics, Chemistry, Biology/Zoology and Botany)

Medium of Instruction & Year of Passing

Name of the School & Address

Total PCB:

%:

Total

Percentage

Family Member Name

Relation to the Student

Age

Educational Qualification

Occupation Govt

Occupation Pvt

Monthly Income

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Submit the following original certificates with 3 sets of Xerox copies at the time of Admission. Failing to submit, the candidate will not be registered for the course.

1.

10^th, 11^th, and 12^th Mark sheets

2.

Transfer Certificate

3.

Community Certificate (for SC/ST, BC, OBC & MBC Only)

4.

Adhar Card (Xerox)

5.

Bank account details (Self) copy

6.

Nativity certificate

7.

Income Certificate

8.

Medical Fitness Certificate

9.

HB Count, Blood Group, Vaccine (TT, Hepatitis B, COVID)

10.

Ration card, PAN card (Xerox), Voter ID

11.

Migration Certificate (for students from outside Tamil Nadu)

12.

Eligibility Certificate (for students from outside Tamil Nadu)

13.

a) Self-attested recent passport-size colour photos (white background, name as in 10^th certificate) – 8 copies

b) Father's photo – 2 (Passport size)

    Mother's photo – 2 (Passport size)

14.

Conduct & Attendance Certificate

Signature of the Applicant

Signature of the Parent