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 rsin g@ imch bd.com www. imch bd.com