Admission Form

Name*
First Last
Father's/ Husband Name*
First Last
Gender*
DOB
Subjects*
Course Choice*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Category & Name Of Cast*
S.No. Exam Passed Name of Board /University Subject Marks Awarded % of Aggregate
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Declaration*
- I hereby declare that information given above is correct. I have thoroughly read the admission rules & regulations supplied by VINAYAK COLLEGE & i shall abide by these rules.

Vinayak College of Nursing

S.No.	Exam Passed	Name of Board /University	Subject	Marks Awarded	% of Aggregate