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Application Form For Migration Course Change
Candidate have to verify their Original Documents.All documents must be attested by principal of the Institute
ऑन लाईन फार्म के साथ अपने समस्त दस्तावेजो की दो प्रति संलग्न करे।
नोटः- ए.एन.एम से जी.एन.एम एवं जी.एन.एम से पोस्ट बेसिक करने वाले छात्र भरे।
Field's marked with * are mandatory
Migration Change Subject Details
Migration Required*
Personal Details
Applicant's  Name
(Don't use Mr./Mrs./Ku.) *
Father's / Husband Name* Mother's Name
DOB(DD/MM/YYYY)* Age(Till Current Date)
Marital Status * Religion *
Caste Nationality *
Gender * Category *
M.P. Domicile* District :*
Other State* Other State District
Mobile Number *
Email* Institution Recognized by INC*
Training Details
Name of Examination University/Council from which Qualified*
Training Center Name
(Govt/Private)*
Training Period From Date(DD/MM/YYYY)* Training Period To Date(DD/MM/YYYY)*
Are you Completed Your 6 Moths InternShip(G.N.M.)
Desired Training Center Address *
Desired School/College Name*
Candidate Address
Current Address *
Pin Code * Permanent Address(Same as Current Address)
Permanent Address *
Pin Code *
Educational Qualification Details
S No.ExamNameBoard NameSubjectPass YearPercentageRollNumber
1 High School(10th)*
2 Higher Secondary(12th)*
3 ANM/GNM/B.Sc Nursing (Enter Highest Qualification)*
4 Other1
Annexure, Testimonials & Particulars Registration MP Nurses Council or Other Council
1. Annexure*
2. Copies of Testimonials* (Name, Address & Designation of testifying Persons and date of issue of testimonial)
Testimonials Person 1
Testimonials Person 2
Work Experience
Work Exp.(From Date)(DD/MM/YYYY)* Work Exp.(To Date)(DD/MM/YYYY)*
Name of Work Place* Address of Work Place*
Have you ever been penalized by any Court Law ?*
Declaration

Upload your photo*
(Min 15 kb -Max. 50 kb)(Only .Jpg Format is Allowed)
* I enclose original copies of certificates of qualification as detailed below, which may please be returned to me. I also enclose Two recent testimonials by respectable and well known citizens of my town/village including one by a Medical Officer not below the rank of Assistant Surgeon or a private Medical Practitioner holding registrable medical qualifications. I hereby undertake that if I am admitted to register, I will , in the practice of my profession as a observe and be bound by the provision of the Act and the rules and byelaws made or order and instructions, issued there under so far as they affect me and if the Council shall at any time after due enquiry order my name to be removed from the register. I will return to Registrar the certificate and badge (If any) issued to me by the council.
Note:- 1.Candidate have to verify their Original Documents . All documents must be attested by principal of the Institute