ST. PHILOMENA’S COLLEGE OF NURSING

St. Philomena’s Hospital No.1 Mother Theresa Road, Viveknagar PO, Bangalore

Application for admission to Master of Science in Nursing ( M.Sc Nursing)

Note:The Application should be filled with complete information. Kindly take a screenshot of the filled application form, before submitting it. You are expected to mail the screenshot to stphilomenascon@yahoo.com to help us identify you in case of technical adversities.

Please do the payment first and then fill the application form

Enter Payment reference Number:

Application No

Candidate Photo:

Candidate Name in full :

Father’s Name :

Mother’s Name :

Date of Birth

Age :

Gender :MaleFemale

Place & State of Birth :

Blood Group:

Religion :

Mother Tongue:

SC/ST/OBC/Other :

Caste name :

Occupation & Annual income of the Father :

Occupation & Annual income of the Mother :

State of Domicile :

Permanent Address :

PIN Code :

Email Address :

Present Address (Address for Correspondence) :

Mobile Number & Email ID of Father :

Mobile Number & Email ID of Mother :

Concerned State Nursing Council Registration No :

Year of Experience :

Sepciality :Medical Surgical NursingOBG NursingMental Health Nursing

Educational Qualification:

Attach all your S.S.L.C educational documents :

Attach all your H.S.C educational documents:

Attach all your B.Sc(N)or PB.B.Sc(N) educational documents:

Attach all your Other educational documents:

Are you related to any staff of St. Philomena’s Hospital/College of Nursing, Bangalore?YesNo

If YES, give the name and relationship :

Date :

Payment Details:-

Bank Name : The South Indian Bank Ltd

Branch : St.Philomena’s Hospital Branch, Bangalore – 560 047

A/c No: 0593053000002518

IFSC Code : SIBL0000593

Narration : Strictly write Application No. first and Applicants Name

If not office is not responsible since we cannot trace the applicant

Application Fee – Rs.750/-

For Office use only:

Note:

Incomplete application and those without the required documents will not be considered.