Name of the course opted (please tick) :
    Name of the Candidate :
    (in block letters) :
    Mother’s Name :
    Date of Birth :
    (as per SSC Certificate)
    Marital status :
    Languages know :
    RN & RM number :
    Name of the Nursing Council:


    GNM/B.Sc. Year of Passing Percentage of Marks

    Experience (in chronological order, starting from the most recent one)

    Name of the Institute/Organization Work experience in labour room/ Neonatal ICU/ Paediatric ward.
    From To
    Work experience in teaching
    From To

    Total years of experience

    Clinical Teaching

    What motivated you to apply for the Post Basic Diploma Course in Nurse Practitioner Midwifery/Neonatal Nursing ?
    Permanent Address :
    Phone :
    Email :
    Local Guardian Address (if any) :
    Phone :
    Email :
    Please tick, if you have original copies of below ( To be submitted at the time admission for verification ) :

    To submit you application please scan the QR code below enter amount of Rs500/- make the payment and enter the transaction /reference ID and submit.

    Transacation Id/Reference ID :

    Stork Home Annexe, Road No. 12, Banjara Hills, Hyderabad, Telangana – 500 034
    M +91 8008500598 P 04024760860 | E | W

    The Indian Nursing Council, New Delhihas recognized FERNANDEZ SCHOOL OF NURSING vide Certificate No. 18-02/5098 – INC
    The Government of Andhra Pradesh has sanctioned FERNANDEZ SCHOOL OF NURSING vide G.O. Ms. No. 471 dated 2.11.2004
    and Andhra Pradesh Nurses & Midwives Council letter No. APNMC / GNM / 5192 / 2008 dated 28.01.2008