St. Joseph College of Nursing Mukkam

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Management Merit Quota

Application No. *

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Personal Details

Name in Block Letters *

Date of Birth *

Aadhar No. *

Religion *

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Gender *

Nationality *

Blood Group *

Caste & Category *

Email *

Parent / Guardian Details

Full Name*

Relationship *

Mobile No *

Email *

Present Address with pin code and nearest landmark

House name / Door No./ Flat No*

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Landmark if any *

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State *

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Permanent Address with pin code and nearest landmark

House name / Door No./ Flat No*

Street / Lane *

Landmark if any *

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Pincode *

Mobile No *

Details of the Qualifying Examination

Name of the Institution and State*

Year of Passing*

Register No *

Marks Obtained in 12th Standard only

Subject	Plus Two / HSE / CBSE / ISE		Percentage of Marks
Subject	Marks Obtained	Maximum Marks	Percentage of Marks
Physics
Chemistry
English
Biology / Equivalent
Total

Documents uploaded along with the application

Copy of the relevant page of SSLC Book / Equivalent Board Certificate as proof of age and Date of Birth
Copy of the certificate and mark list of qualifying examination (Plus Two / CBSE) or print out of the result sheet from the website.

Declaration by the applicant

I hereby declare that I have read the various clauses in the prospectus for admission to BSc Nusing Course and the instructions carefully and I agree to abide by them.
I also declare that all statements in the application are true, complete and correct to the best of my knowledge and belief.

Name and Signature of the applicant (Digital Signature)

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Date and time of application submitted *

Application for BSc Nursing under Management Quota Seat – 2025-2026