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Form No
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MPNRC3374
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| ENROLLMENT APPLICATION FORM |
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| ENROLLMENT NO : |
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PHOTO & SIGNATURE |
| CURRENT STATUS : |
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 |
| APPLIED COURSE : |
GNM New First Year |
| APPLIED SESSION : |
2022-23 |
| DATE OF ADMISSION : |
17/08/2022 |
| INSTITUTE NAME : |
Shri Chaitanya College of Nursing Sciences (36106) Sagar |
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| APPLICANT NAME : |
SANJANA AHIRWAR |
DATE OF BIRTHDAY : |
17/01/2004 |
| GENDER : |
Female |
AGE : |
20 Y, 7 M, 17 D |
| FATHER'S NAME : |
KAMLESH |
CASTE : |
AHIRWAR |
| MOTHER'S NAME : |
LEELA |
CATEGORY : |
SC |
| RELIGION : |
HINDU |
MARITAL STATUS : |
Single |
| MOBILE : |
9575451532 |
E-MAIL : |
sourabhkingroy89@gmail.com |
| CURRENT ADDRESS : |
SULABH COMPLEX KE SAAMNE, KAKAGANJ WARD , SAGAR |
| PERMANENT ADDRESS : |
470002 |
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| TOTAL FEE : |
₹ 240 |
PAYMENT STATUS : |
TXN_SUCCESS |
| TRANSACTION ID : |
20240528210550000002207120177166970 |
TRANSACTION DATE : |
28 May 2024 13:34:00:000 |
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| S.N |
EXAM NAME |
BOARD NAME |
STATE |
SUBJECTS |
PASS YEAR |
PERCENTAGE |
| 1 |
High School (10th) |
BOARD OF SECONDARY EDUCATION MADHYA PRADESH BHOPAL |
Madhya Pradesh |
ALL |
2019 |
54.6 |
| 2 |
High Secondary School (12th) |
BOARD OF SECONDARY EDUCATION MADHYA PRADESH BHOPAL |
Madhya Pradesh |
ECONOMICS |
2021 |
49.2 |
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| 10TH MARKSHEET |
12TH MARKSHEET |
AADHAAR CARD |
CAST CERTIFICATE |
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I hereby declare that the entries made by me in the Application Form are complete and true to the best of my knowledge, belief and information.
I hereby accept that the information provided in the application form will not be altered in the foreseeable
future
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STUDENT SIGNATURE |
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