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Full Name of the Applicant (As Per SSLC Marks Card)
Your Phone Number
Courses Offered In Nursing
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GNM Nursing
B.Sc. Nursing
Post B.Sc. Nursing
M.Sc. Nursing
Non
Courses Offered In Pharmacy
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D. pharm
B.pharm
Pharm D.
Non
Courses Offered In Paramedical
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B.Sc. Cardiac Technology
B.Sc. Perfusion Technology
B.Sc. Anaesthesia
B.Sc. Dialysis
B.Sc. Optometry
B.Sc. Medical Laboratory Technology
B.Sc. Operation Theatre Technology
Physiotherapy (BPT)
B.Sc. Radiology
Non
Date of Birth
Your Age
Full Name of Father/Guardian
Nationality
Gender
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Male
Female
Transgender
Mother Tongue
Father's Name
Mother's Name
Permanent Address of the Applicant
Pin Code/Zip cod
Local Address of Guardian
Pin Code/Zip cod
Name of the School /
College last attended
Qualifying Exam Passed (S.S.LC/PUC/Other. (If other please specify
Month & Year of PassingL
Register Number in the qualifying exam passed
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