APPLICATION FOR ENROLMENT

ID CardPhotograph

Please staple a passport sized

photograph to this box. Please write your nameand birth date on reverse

of photograph

PART 1 - ACADEMIC PLANS

PART 2 - PERSONAL DETAILS

Course :

5. Religion: Caste

7. Nationality: NRI Foreign SAARC

1. Please print your legally documented name. Name:

6. Community: SC ST OBC Others

8. Domicile: Karnataka Others

9. Blood Group: 10. PAN Number 11. ADHAR Number.

12. NEET Ranking : ADDRESSES13. MAIN CONTACT ADDRESS ALTERNATIVE CONTACT ADDRESS This is where all our mail regarding your application will be sent. (e.g. Parents, Relative - this address will be used in the

2. Date of Birth 2A Age: years 3. Gender: Male: Female:

4. Father’s Name: Mother’s Name:

Day Month Year

TELEPHONE

The College/ Institution will allow the student to go out of the campus monthly once on holidays and in case of emergency only with the due request from the parents/ local guardian and in such cases the parent/ local guardian will be responsible for student’s safety & their actions.

City/ Town City/ Town

FAX

Please place my mail address on the PGI mailing list (Tick)

14. LOCAL GUARDIANS CONTACT ADDRESS

RELATIVE FAMILY FRIEND OTHERS

Please indicate your relationship with the local guardian

E-MAIL ADDRESS

City/ Town: TELEPHONE MOBILE

Please make sure you keep it up to date and advice us if it changes. event we cannot contact your main contact address).

TELEPHONE TELEPHONE EMERGENCY CONTACT

DAY/ TIME WORK TELEPHONE

B.Sc. Nursing GNM

AISHWARYA INSTITUTIONS®

(A Unit of Aishwarya Educational & Charitable Trust )

Sy. No. 146 & 147, B.M. Road, Marakadadoddi, Near H.K.V. NagarMaddur-571 428, Mandya Dist. KARNATAKA, INDIA

18. Marks secured in qualifying examination

Subjects Marks %

Secondary School attended

17. Medium of Instruction in pre university education (10 + 2) / Qualifying examination

Name of the School/ College attended with Address

Optional Subjects

15. Secondary Education

16. Pre University education (10 + 2) / Qualifying examination

Total

PART 3 - PREVIOUS ACADEMIC EDUCATION

PART 4 - DOCUMENTS REQUIRED

10th Marks Card Migration Certificate Nationality Certificate

10+2 Marks Card Date of Birth Certificate (Applicable only for international students)

Transfer Certificate Domicile Other

Please tick the relevant box whichever is applicable for which the copy of the documents is enclosed along with this application.

Passport copy

PART 5 - STUDENT DECLARATION

I. I hereby agree that I will not cause any damage to the college and hostel property, I accept that failure on my part to abide by this policy may lead to necessary disciplinary action and any related costs incurred by my actions will be recovered from me.J. I am aware that delay in payment of the Tuition/ Hostel fees attracts a late fee (fine) until such time as I have paid the same.K. I agree that it is an essential term of my agreement with AECT that information I have given in this form and any attached documents is true and complete and acknowledge that AECT may suspend my enrolment if false information has been furnished or required information is not given by the due date.

H. I am aware that consumption of alcohol and smoking is prohibited in the College and Hostel and I agree to abide by this condition failing which necessary disciplinary action can be taken against me.

E. I am aware that it is mandatory for all the students to stay in the hostel and agree to abide by this condition for the full tenure of my educational course at AECT

G. I am aware that whenever I need to go out of the Hostel I have to take the permission from the Principal/ Chairman/ Vice Chairman / Warden by giving an written application for the same. I am aware that I can be suspended from the College and Hostel for not complying with this condition.

STUDENT’S SIGNATURE DATE

A. I agree to abide by the laws and regulation of the (AECT)®A Unit of Aishwarya Educational & Charitable Trust

C. I am aware that 80% attendance is mandatory in all the subjects for a student to be eligible to appear for the University Examinations.B. I acknowledge that if I am accepted for a course of study I am liable to pay the fees for the full term and it will not be refunded under any circumstances.

D. I acknowledge that I am aware about the payment of Hostel Development fund of which is not refundable.

F. I am aware that usage of two wheelers is not allowed in the college campus and in the hostel.

FATHER / MOTHER / GUARDIAN’S SIGNATUREPlease Return to: Admission SectionAISHWARYA INSTITUTIONS

® (A Unit of Aishwarya Educational & Charitable Trust )Sy. No. 146 & 147, B.M. Road, Marakadadoddi, Near H.K.V. Nagar, Maddur-571 428Mandya Dist. KARNATAKA, INDIA