Disha Nursing Institute | Admission Form

Admission Open for 2024-25 Session, Call - 6296186941 / 6297592072 / 6297361023 / 7047714390 Swami Vivekananda Scholarship Available Facebook

Course for Admission

Student Information

First Name *

Middle Name

Last Name *

Email Address *

Phone Number *

Gender *

Other Information

Date of Birth *

Blood Group

Religion *

Caste *

Mother Tongue *

Aadhaar Card Number *

Physically Disabled *

Extra-Curricular Activities

Current Address

Vill / City *

Post Office *

Police Station *

District *

State *

PIN *

Parmanent Address is same as Current Address

Parmanent Address *

Guardian Information

Father's Name *

Father's Occupation *

Mother's Name *

Mother's Occupation *

Correspondence Address *

PIN *

Phone Number *

Qualification 1 (Required)

Qualification *

School / College *

Subject *

Percentage *

Year of Passing *

Remarks

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Student's Photo *

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Student's Sign *

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Aadhaar Image *

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Caste Certificate *

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Class-10 Marksheet *

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