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ANANDA SOCIAL & EDUCATIONAL TRUST (R.
)
Dr. B.R. AMBEDKAR INSTITUTE OF NURSING
Recognised by Indian Nursing Council, New Delhi &
Affiliated to Rajiv Gandhi University of Health Sciences, Bengaluru
# 24, Dr. B.R. Ambedkar Medical College & Hospital Campus, Kadugondanahalli, Bengaluru - 560 045
Mobile : 09902497584 • Email : [email protected] • Website : www.drbrain.in
APPLICATION FOR ADMISSION TO M.Sc.(N) NURSING COURSE
Application No. : Issued on : Receipt No. : Affix a recent

passport size
photo attested
Important : Students admitted in this college are governed by the rules & regulations of the college. All entries by a
Gazetted Officer
must be made be in English in Capital Letters only. Please read the instruction before filling the application.
Name of the Candidate :
Father's Name / Husband Name :
Mother's Name :
Age of the Candidate : Date of Birth : Gender :
Nationality : Religion : Caste / Sub-Caste :
Whether candidate belongs to SC / ST / Others :
Backward Class (Valid Document to be produced – Karnataka Candidates only) :
Mother Tongue : Blood Group :
Extra-Curricular Activities :
Postal Address :
Annual Income :
Contact No. (a) Father : Email :
(b) Mother : Email :
(c) Student : Email :
(d) Residence Ph. No.
Local Guardian's Name & Address:
Phone No. : Email:
Previous Institution Studied: Register No. :

Name of the Principal: University / Board:
Address & Phone No. :
Course Studied Year of No. of Attempts Marks Obtained Aggregate%

Passing 2nd
(Percentage)
1st 3rd 4th
Yr Yr Yr Yr
B.Sc. (N)
--------- ---------
PB B.Sc. (N)
TOTAL
List of Original Certificates Submitted :
Sl.No. CERTIFICATES YES NO REMARKS
1 SSLC or 10th Std Marks Card

2. PUC or +2 Marks Card
3. B.Sc. (N) or P.B.B.Sc Marks Card
4. Course Completion Certificate
5. Attempt Certificate
6. Transfer Certificate
7. Character / Conduct Certificate
8. Convocation Certificate
9. KNC Registration Certificate
10. Migration Certificate
11. Experience Certificate (Minimum 1 Year)
12. Physical Fitness Certificate
13. Residential Certificate (Aadhar Card)
14. Caste Certificate (For SC/ST/OBC Candidates)
15. Income Certificate (for SC / ST / OBC students)
16. Eligibility Certificate from RGUHS
17. Passport Size Photo (10 NOs)
18. Passport (If Available)
19. Citizenship Card (Only For NRI)
NOTE: Five sets of Xerox copies of above certificates.
ELIGIBILITY CRITERIA / ADMISSION REQUIREMENTS
➢ The candidate should be Registered Nurse and Registered midwife or equivalent with any State Nursing Registration Council.
➢ The minimum education requirements shall be the passing of B.Sc. Nursing / B.Sc. Hons. Nursing / Post Basic B.Sc. Nursing
with minimum 55% aggregate marks.
➢ The candidate should have undergone in B.Sc., Nursing / B.Sc. Hons. Nursing / Post Basic B.Sc. Nursing in an institution
which is recognized by Indian Nursing Council.
➢ Minimum one year of work experience after Basic B.Sc. Nursing.
➢ Minimum one year of work experience prior or after Post Basic B.Sc. Nursing.
➢ Candidate shall be medically fit.
➢ 5% relaxation of marks for SC/ST candidates may be given.
RULES & REGULATIONS TO BE FOLLOWED BY THE STUDENTS OF DR. BRAIN

➢ The college lays great emphasis on decent behavior from every student.
➢ Students should wear the prescribed college uniform for clinical duty / college.
➢ Every student shall always wear his/her identity card within campus.
➢ Students should be neatly dressed and girls should put up their hairs up and no jewels should be worn by the
Students while on clinical duty.
➢ Students should maintain punctuality and decorum of the college.
➢ The college begins at 09.00 AM and closes at 04.00 PM with a lunch break between 01.00 PM to 02.00 PM. No
student should leave the classroom during a lecture without the permission of the Class Co-ordinator/ Subject
Teacher.
➢ Students should be regular to the classes. They will not be permitted to the class 5 minutes after the
commencement of the class.
➢ Loitering in the corridors (or) in the campus during college working hour is strictly prohibited.
➢ For any queries / problems the students should approach their concerned class co-ordinator through their
class representative.
➢ Students should respect each other and follow the guidelines of all the teaching / non-teaching staffs.
➢ No meetings / birthday parties of any kind shall be held within the class room / campus without the prior written
permission.
➢ Stu dents must produce leave letter fo r their absence wi th the signature of their class
co-ordinator / hostel warden / principal.
➢ Students should maintain strict discipline inside the class room as well as in the college campus, they should
keep the class room / hostel neat and tidy.
➢ Student should refrain from disfiguring walls and furniture and from other objectionable practices.
➢ All students should speak in English in the class room as well as in the college campus.
➢ Students should put up a minimum attendance of 80% in all subjects of the year as laid down by the Rajiv
Gandhi University of Heath Sciences. Students, falling short of 80% of class attendance & 100% of practical’s,
shall not be allowed for the University Examination at the end of the year.
➢ Students those who promoted to next class should pay 50% of the total fees (Tuition fees 25% + Mess / Accom.
25%) while rejoining to the college and the remaining 50% should be cleared within three months.
➢ Any suggestions / grievances of the students can be brought to the notice of the authorities through suggestion box.
➢ “Ragging is strictly prohibited”.
➢ All candidates who secure admission in the college are deemed to have agreed to all the rules and regulations
given hereunder and such rules and regulations has to be added / amended from time to time.
DECLARATION BY THE CANDIDATE
I Mr / Ms………………………........................................………….S/o D/o………............………………………….abide
by the rules and regulations of the college and hostel. I declare that, I will not opt other courses in between the nursing
course. I agree that I am bound by the rules and regulations in force or which may be framed by the management from
time to time. I undertake that so long as I am the student of the college, I will do nothing unworthy of a student of this
college either inside or outside and I will not instigate or participate in ragging or do anything that will interfere with the
working and discipline of the institution. I am aware that the management have full authority to expel me for
indiscipline, mis-behavior or any other such activities which are detrimental to the fair name of the institution. In the
matter of discipline, the decision of the college authorities shall be final and binding upon me. I declare that the
information provided in the application form is true to the best of my knowledge and belief.
Date :………………
Place :………………. Signature of the Candidate
DECLARATION BY THE PARENT/ GUARDIAN
I Mr / Ms……………………………………………………..Parent / Guardian to hereby declare that I know the financial

obligations and that I can afford to pay and undertake to pay all costs, tuition and other fees payable to the institution
under the rules framed by the management of the college from time to time. I also declare that I will not question any
disciplinary action which may be taken by the management against my son / daughter / ward for indiscipline or such
other activities by him / her which are detrimental to the interest of the college.
Date :………………
Place :………………. Signature of the Parent/Guardian
Admitted By : Address :
Mobile No. : Email:
OFFICE USE
Package / Yearly Fees : …………………….
1st Year 2nd Year TOTAL
SIGNATURE OF THE CASE WORKER SIGNATURE OF THE MANAGER
SIGNATURE OF THE PRINCIPAL SIGNATURE OF THE CHAIRMAN

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ANANDA SOCIAL & EDUCATIONAL TRUST (R.

APPLICATION FOR ADMISSION TO M.Sc.(N) NURSING COURSE

Application No. : Issued on : Receipt No. : Affix a recent

Name of the Candidate :

Father's Name / Husband Name :

Age of the Candidate : Date of Birth : Gender :

Nationality : Religion : Caste / Sub-Caste :

Whether candidate belongs to SC / ST / Others :

Backward Class (Valid Document to be produced – Karnataka Candidates only) :

Mother Tongue : Blood Group :

(b) Mother : Email :

(c) Student : Email :

(d) Residence Ph. No.

Local Guardian's Name & Address:

Phone No. : Email:

Previous Institution Studied: Register No. :

Course Studied Year of No. of Attempts Marks Obtained Aggregate%

List of Original Certificates Submitted :

Sl.No. CERTIFICATES YES NO REMARKS

1 SSLC or 10th Std Marks Card

➢ Minimum one year of work experience after Basic B.Sc. Nursing.

➢ Candidate shall be medically fit.

➢ 5% relaxation of marks for SC/ST candidates may be given.

RULES & REGULATIONS TO BE FOLLOWED BY THE STUDENTS OF DR. BRAIN

➢ “Ragging is strictly prohibited”.

Place :………………. Signature of the Candidate

DECLARATION BY THE PARENT/ GUARDIAN

I Mr / Ms……………………………………………………..Parent / Guardian to hereby declare that I know the financial

Place :………………. Signature of the Parent/Guardian

Mobile No. : Email:

1st Year 2nd Year TOTAL

SIGNATURE OF THE CASE WORKER SIGNATURE OF THE MANAGER

SIGNATURE OF THE PRINCIPAL SIGNATURE OF THE CHAIRMAN

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