Admission Form NMW

Form No: _________________
PATEL HOSPITAL
(A Project of Patel Foundation)
PATEL COLLEGE OF NURSING & ALLIED HEALTH SCIENCES
Recognized by Pakistan Nursing Council
Admission Form
Session: ____________
Paste recent
passport size
photograph
1 Year Diploma- Nurse Midwifery
PERSONAL INFORMATION:
Name:____________________________________________________________________________
(In block letters as per SSC or equivalence certificate)
S/O, D/O, W/O:__________________________________________________________________

(In block letters as per SSC or equivalence certificate)
Date of Birth: _________________________________Gender: Male Female
CNIC No: - -
PNC Registration No:( For Nurse Midwives)
Current Address: __________________________________________________________________

_________________________________________________________________________________
Permanent Address: _______________________________________________________________
_________________________________________________________________________________
Landline #: _______________Mobile #: _______________ Occupation: _____________
Domicile: ________________ Nationality: ________________ Religion: ________________
Marital Status: Single Married Widow
Next of Kin: ______________________________________________________________________
Relationship: ______________________________________________________________________
Address: _________________________________________________________________________
Landline #:___________________________ Mobile #: _________________________________
PHK/PINAHS/ADNMW/42 Page 1|3

EDUCATIONAL INFORMATION:
 Academic Qualification:
Academic Year of Total Marks Name of Board/ Major

%
Qualification Passing Marks Obtained Institute University Subjects
Matriculatio
n
H Sc. (Part
II)
B.A/BSc./B.C
om
Others
 Professional Qualification:( For Nurse Midwives)
Professional Year of Total Obtaine Division Name of Board/ Major

Qualification Passing Marks d Marks / Grade Institute University Subjects
General
Nursing
Others
WORK EXPERIENCE: (If applicable)
Note: Provide the last 3 years starting from the latest.
Date of
Total Experience
# Name of Organization Designation Department Employment
To From Year Month Day
1
Note: It is mandatory to submit the verified work experience certificate.

Declaration:
It is to certify that the above-mentioned information is true and correct. If any content or document
found incorrect or false any action against me may be taken (i.e. revoke my admission or termination
or training any time).
__________________ ________________________
Signature of candidate Signature of Parents/Guardian

Reference No. 01:
Name: ___________________________________________________________________________
- -
CNIC No:
Designation: ______________________________________________________________________
Address: _________________________________________________________________________
Landline No: ______________________________ Mobile No: __________________________
Reference No. 02:
Name: ___________________________________________________________________________
- -
CNIC No:
Designation: ______________________________________________________________________
Address: _________________________________________________________________________
Landline No: ______________________________ Mobile No: __________________________
Eligibility Criteria
Track-I:
Qualification:
 Secondary School Certificate
 General Nursing 03 Years Diploma Program.
 01 Year Nurse Midwifery (Post Basic Specialty for female)
 Completion of 3 compulsory courses i.e. English, Islamic and Pakistan Studies at BSc Level
 Valid Registration with Pakistan Nursing Council or equivalent.
Experience: 02 years clinical experience (Post experience of specialty)
PNC Registration: Valid registration with all entries of professional qualifications
Track-II:
 Higher Secondary School Certificate
 Successful completion of 4-year Generic BSCN Program.
 2 Year’s Clinical experience including 1-year Internship in a hospital.
 Valid Registration with Pakistan Nursing Council or equivalent.

Admission Form NMW

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Admission Form NMW

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Form No: _________________

1 Year Diploma- Nurse Midwifery

S/O, D/O, W/O:__________________________________________________________________

Date of Birth: _________________________________Gender: Male Female

PNC Registration No:( For Nurse Midwives)

Current Address: __________________________________________________________________

Marital Status: Single Married Widow

Next of Kin: ______________________________________________________________________

Landline #:_ Mobile #: _______

PHK/PINAHS/ADNMW/42 Page 1|3

Academic Year of Total Marks Name of Board/ Major

 Professional Qualification:( For Nurse Midwives)

Professional Year of Total Obtaine Division Name of Board/ Major

WORK EXPERIENCE: (If applicable)

Note: Provide the last 3 years starting from the latest.

Note: It is mandatory to submit the verified work experience certificate.

PHK/PINAHS/ADNMW/42 Page 2|3

PHK/PINAHS/ADNMW/42 Page 3|3

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