Charkos Group of Institutions

(Affiliated to Rajiv Gandhi University of Health Sciences, Bengaluru,
Recognized by Karnataka State Nursing Council and indian Nursing Council)

5, C-1, A-1 Block, 3rd Stage, Vijay Nagar 3rd Stage, Vijayanagar, Mysuru, Karnataka 570030, India

Application Number:

Course Applied For:

Year:

Date:

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Name of the applicant (In Block Letters)

Name of the Father

Name of the Mother

Occupation of the Parent Guardian

Age & Date of Birth (Copy of SSLC/ 10th marks to be enclosed)

Religion & Cast

Nationality

Mother Tongue

Marital Status

Aadhaar No.

Medical disability (if any)

Contact Number

Alternate Mobile number

E-mail ID

Present Postal Address

Permanent Postal Address

If SC/ST/ Backward class particulars to be given (Enclose supporting documents)

Education Qualification