Brahmaputra College

Srimanta Sankaradeva University of Health Sciences
Assam Nursing Council, Guwahati
Gauhati Medical College & Hospital

Director of Medical Education, Govt. of Assam

Department of Medical Education, Govt. of Assam

Course:

Name:

Father's Name:

Mother's Name:

Date of birth:

Gender: *

Male Female Trigender

Community:

Nationality:

Religion:

Caste:

Address:

Pincode:

Student's Contact No:

Guardian's Contact No:

Email:

Last Examination Passed:

Guardians Occupation:

Last Eduactional Details:

Course

Board/University

Subjects

Marks (Marks Obtain/Total Marks)

Percentage

Division

Year of passing

I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief.

Brahmaputra College of Nursing and Health Sc.