Chandidas Institute of Nursing and Paramedical Science

Hospital Road, Nanoor, West Bengal - 731301

Phone: +91 8101579839 / 8436474659

Email: cinp.official@gmail.com

Website: www.cinpsjournal.com

Scholarship Exam Application Form

Academic Year:

Application No:

1. Personal Information

Full Name:

Date of Birth:

Gender:
Select Male Female Other

Category:
Select General SC ST OBC Minority

Aadhar Number:

Father's Name:

Mother's Name:

Guardian’s Name (if applicable):

Permanent Address:

Mobile Number:

Email ID:

2. Academic Details

Last Qualification:

Year of Passing:

Board/University:

Percentage/CGPA:

Course Applied For:
Select DOTT DMLT ICU Technician EMT

Institute Branch:
Select Nanoor Sainthia Ranishwar

3. Exam Details

Preferred Exam Center:
Select Nanoor Sainthia Ranishwar

Preferred Exam Language:
Select English Bengali Hindi

Exam Date Preference:

4. Documents to be Attached (Self-attested copies)

Marksheet of the last qualifying examination

Aadhar Card

Category Certificate (if applicable)

Passport-sized photograph

5. Declaration by the Applicant

I hereby declare that all the information provided in this application is true and correct to the best of my knowledge. I understand that providing false information may result in the rejection of my application. I agree to abide by the rules and regulations of the scholarship exam.

Signature of the Applicant:

Date:

6. Examination Committee Approval (For Office Use Only)

Verified By:

Remarks:

Exam Application Approved:
Select Yes No

Exam Date Assigned:

Signature of the Exam Coordinator:

Date:

Submit Application