An Aided institution of Department of Atomic Energy and a Deemed to be University under section 3 of the UGC Act.
Regd. Office: 2nd Floor, Training School Complex, Anushaktinagar, Mumbai 400 094
Enrolment Form for Admission to M.Sc./ M.Sc. (Nursing) /
M.Sc. (Clinical Research) / Int. M.Sc. Programme
Year 20…..-- 20….. / Affix Recent self attested photograph
3.5 x 2.5 cm
Please sign across
a. Application No(To be filled by CI)
A / P
/ Enrolment No(To be allotted by HBNI)
b. Constituent Institution(CI) Name / Off Campus Centre (OCC) Name:
I desire to enroll in HBNI as a regular student to the______programme. My details are as follows:
1. Full Name (as per last Qualifying Degree)
(It is mandatory to write name in Hindi also)
2. Aadhaar Card No. (Self attested copy of the card to be attached)
3. Date of Birth (DD/MM/YYYY)
4. Father/ Mother’s Full Name
5. Address for Correspondence
6. Permanent Address
7. Telephone & Mobile No.
8. Email-ID
9. Category (General/ SC/ ST/ Others(specify))
10. Nationality
11. Male/ Female/Transgender
12. Whether Physically/ Visually Challenged (Yes/No, if Yes give details)
13. Educational Qualifications(starting with graduation degree)
Sr.No
/Degree
/ Year / % Marks / Subjects / University1. /
2. /
3. /
4. /
Certified that I am not enrolled in any other Programme of any University. The above information furnished by me is true and correct. If any information is found to be incorrect or false, I understand that my admission shall be liable to be summarily terminated without notice.
Date: Signature of the Student
Recommendation by the Designated Authority
Certified that the entries made by the student have been verified from the documents submitted. He/she is eligible for admission to the programme mentioned below as per the relevant ordinance of HBNI.
The said student is recommended for admission in Programme…………………………………….
Date: Signature of Designated Authority with stamp
Verified the application for enrollment and found to be complete with all enclosures.
Date: Dean-Academic (Health Sciences), CI
To: Dean, HBNICHECK-LIST OF MANDATORY ENCLOSURES FOR APPLICANT
The fee (as applicable) to be paid in the form of crossed DD drawn in favour of: “Accounts Officer, HBNI”.
DD No. / Date / Drawn on Bank / Branch / Amount (Rs.)Self attested Photocopies of all Mark Sheets, Degree Certificates and Proof of Date of Birth.
Enrolment Form: M.Sc / M.Sc.(Nursing) / M.Sc (Clinical Research)/ Int. M.Sc Programme 1/2