INTERNATIOI{AL MEDICAL COLLEGE

INTERNATIOI{AL MEDICAL COLLEGE
B.Sc. NURSING UNIT
GUSHULIA, SATAISH, TONGI, GAZIPT]R
c. NIIKSTNG
01
Name of the Candidate
(In Block letters)
02 Father's Name
03
04
05
06
07
08
(a) Occupation
Mother's Name
(b) Occupation
Date of Birth
Marital Status
Nationality
National ID/ Passport No.
Religion & Caste
09 Permanent Address
10
Present Avlailing Address
11
Parents Contact Number
Name of local Guardian
with Contact Number
Relation with Students
t2
l3
I4. Educational Oualifications:
Signature of the applicant
Photograph
2 Copies
THE FOLLOWING DOCUMENTS IIAVE TO BE ENCLOSED \YITH TIIIS APPLICATION TORM
A. Original
B. Attested
l\,Ioney Receipt of the application form
Testimonials from the School & College.
C.
Four copies of attested photographs (Passport size) of the Applicant.
D.
Attested copies of Grade Sheets of SSC and HSC.
ITIB: SUBMISSION OF
ORIGINAL CERTIFICATES/ DOCUMENTS AT THE TIME OF
GETTING AD]VtrTTED INTO THE COLLEGE IS MAI\DATORY.
DECLARATION
I do hereby solemnly declare and legally bind myself to conform to the rules and regulations
of the International Nursing College at present in force or may hereafter be made in future
and I do undertake that I will do nothing either inside or outside the Unit that will interf'ere
the discipline of the Unit as well as the ordinances of Dhaka University relating to B.Sc. in
Nursing, Curriculum as long as I remain as student of Intemational Nursing College.
If the information provided in the Application Form and Documents submitted by me rvith
the application are found to be incorrect, in any time of my study periocl. I shall be liable to
be expelled from the study of B.Sc. in Nursing any other punitive measures may be taken
against me by the College Authority and all types of Fees and other Charges paid by me to
the College up to that time shall be forfeited.
I do further solemnly
declare that there is no personal, domestic or financiai circumstance
that may refrain me from continuing my studies in the B.Sc.in Nursing urtil cornpletion of
the entire course. I also promise that I will remain urmaried till successful completion of
B.Sc.in Nursing.
I also declare that I will not take part in any activities subversive to the State or of discipline
of the institution. I do hereby confirm that the above statement is true and correct.
Name &Signaturc
of the guardian
Name &Signature
of local guardian
Name &Signature
of the applicant
Principal
International Nursing College
Signature & Designation
of the Admission taken person
ADDRESS CORRESPON DENCE:
GUSHULIA, SATAISH, TONGI, GAZIPUR, PHONE: 98L47L3,98L4714,9814550, 01758579282
Fa"x: 880-2-98
1
4550, E-mail : [email protected],
nu
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