Pier Giorgio Frassati College of Nursing

PIERGIORGIOFRASSATICOLLEGE OF NURSING

Loyoal Nagar, Gandhinagar , Suryapet (Mdl) – 508213., Nalgonda (Dist)

( Affliliated to Dr.NTRHealthUniversity, Vijayawada

Recognised by the Indian Nursing Council & A.P.N.C)

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APPLICATION FORM

Application No:Date of Admission :

Application for admission into Four Years Bachelor of Science in Nursing Degree Course for academic year 2013 - 14

( To be filled in by the Candidate herself)

Date:

PERSONAL DATA

1. Name of the Applicant in full:

( Block Letters) As per S.S.L.C Record

2. Full Name of Father / Guardian:

3. Address of Father / Guardian:

4. ParishChurch and Telephone No.:

5. Age & Date of Birth:

6. Religion:

7. Caste ( SC / ST / BC / OC):

8. Place of Birth:

9. Mother Tongue:

10. Languages Known:

11. Health Condition (Mention if any history:

of chronic illness or physical defect is

present)

12. Permanent Address: …………………………………..

..…………………………………

Mobile No:PinCode:

13. Address for correspondence:…………………………………..

..…………………………………

Mobile No:PinCode:

EDUCATIONAL QUALIFICATIONS

DECLARATION BY THE CANDIDATE

I hereby state that I have filled this form myself and all the information given in this application form are true to the best of my knowledge.

I have read and understood it’s prospectus and I hereby undertake to abide by all the rules and regulations mentioned in the prospectus of PIER GIORGIO FRASATI COLLEGE OF NURSING for the Four years B.Sc, Nursing Degree Course for the Year ______.

I promise that I would not indulge in any form of indiscipline that brings down the name of the institution and nursing profession.

Signature of the Guardian / Guarantor :Signature of the Candidate:

Name & Address:______Dated:

(Relationship)______

Mobile No:

The completed application form should be returned along with the zerox copies of the following documents:

1. Copy of S.S.L.C Memo.
2. Copy of Intermediate / H.Sc Memo.
3. Copy of Transfer certificate.
4. Study & Conduct certificates from 1st to Intermediate.
5. Physical fitness certificate from a registered medical practioner.
6. Caste certificate if SC / ST / BC.
7. Migration certificate other than A.P Students.
8. Recent passport size photographs. (10 Nos)
9. Recommendation letter from Parish Priest, if you are a Catholic.
10. Income Certificate.

Note: - Incomplete application will not be entertained.

- Last date for submission of this application :

Note : Along with this application the applicant is suppose to send Rs 10000/- ( Ten thousand ) as advance to the following College Account.

Here with, we give the details of PGF College of Nursing bank Account for the purpose of transferring money by RTGS, NEFT or through D.D.

Account Name : PIER GIORGIO FRASSATI COLLEGE OF NURSING

Bank : STATE BANK OF INDIA

Account No. : 31525248414

IFSC Code : SBIN0006316

Location of Bank : SURYAPET ( branch ), Nalgonda ( Dist ), A.P