Panasia College & School of Nursing

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Applicant's Form * Mandatory fields

Select the Course *	:

How did you hear about us?	:

Name of the Applicant *	:

Applicant Mobile Number *	:

E-mail *	:


Gender	:

Nationality	:

Date of Birth *	:

Permanent Address *	:

City *	:

Country	:

State *	:

Pin *	:

Parent's work address

Name of the Parent / Guardian	:

Occupation of Parent / Guardian	:

E-mail	:


Mobile Number	:

Additional Info

Local Address of Applicant (if any, in Bangalore)	:

Bangalore Telephone Number	:

Category

Whether the Candidate belongs to SC/ST or BC/BT *	:	Yes No

Whether the Candidate is NRI/Foreign National *	:	Yes No

Results Awaiting	:	Yes No

I declare that I have secured the passing marks as per the norms of the 12th standard board I studied in

Languages studied

First Language	:

Second Language	:

Declaration by the Candidate

I declare that the above information is true and correct to the best of my knowledge and belief.
Declaration by the Parent / Guardian:

I hereby declare that I have known the financial obligtion of my ward and I can afford to pay all the costs and I undertake to pay the Tuition and other fees payable to the College under the rules in force & which may be framed from time to time by the Management. I am aware that the fees paid to the college for admission will be forfeited in case of his/her discontinuation of the studies for any reason. I also stand by the declaration given by my son / daughter to the college.