SON GNM APPLICATION FORM Full NamePresent Address *AreaDist. *State *Postal Code *Country *AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabwePermanent Address *AreaDist. *State *Postal Code *Country *AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabwePhone / Mobile no. *Alternate Phone / Mobile no.Email Address *Date of Birth *Candidates age should not be less than 17 years as on December 31st 2022Sex *MaleFemaleRather not to sayMarital Status *SingleMarriedWidowedHeight *Weight *Nationality *Domicile State *Father's / Guardian's Name *Occupation *Designation *Annual income *Mother's Name *Occupation *Designation *Annual IncomeINRNumber of children *Age of 1st child *Age of 2nd child *Age of 3rd child *Age of 4th child *Age of 5th child *Select your qualification *Select any10th / Matriculation12th / IntermediateName of School / Institution *Enter name of School / Institute in 10thName of Board / University *Enter name of Board / University in 10thSubjects Taken in 10th *Total Marks (Percentage) *Passing Year *Name of School / Institution *Name of School / Institution in 12thName of Board / University *Name of Board / University in 12thSubjects Taken in 12th *Total Marks (Percentage) *Passing Year *Extracurricular activitiesHave you done any other nurses training before? *YesNoCourse Title *Course Duration *Name of the Institute *Add more nurses training details *YesNoCourse Title *Course Duration *Name of the Institute *Add more nurses training details *YesNoCourse Title *Course Duration *Name of the Institute *Name of the person who meet the financial requirements for your training *Are you a sponsored candidate ? *YesNoFor sponsored candidates, uploading a copy of sponsorship letter is mendatoryMother Tongue *Select your mother tongueHindiEnglishNepaliBengaliMarathiTamilTeluguGujratiUrduKannadaOriyaMalyalamPunjabiAssameseSanthaliOtherWrite your mother Tongue *Other Languages Known (Read)Other Languages Known (Write)Other Languages Known (Speak)Select your religion *ReligionHinduMuslimChristianSikhJainOtherEnter your religion *Write your denomination *Pastor's / Elder's name *Address of pastor / elder *Do you had any major illness in the past ? *YesNoDetails of illness *After completion of your training, you will be posted in any one of the EHA hospitals to complete your service commitment. Do you agree? *YesNoWhy do you want to become a Nurse? (Write briefly) *Maximum 1000 characters allowed0 / 1000Reasons for applying to this Nursing School: *Maximum 1000 characters allowed0 / 1000Upload your photograph *Choose FileNo file chosenDelete uploaded fileRecent color photo of candidate. Supported format - jpg, jpeg, png, tiff. Maximum file size - 200 kb.Upload your signature *Choose FileNo file chosenDelete uploaded fileCandidates signature. Supported format - jpg, jpeg, png, tiff. Maximum file size - 200 kb.Upload your 10th Marksheet *Choose FileNo file chosenDelete uploaded fileUpload 10th marksheet. Supported format - .pdg only. Maximum file size - 200 kb.Upload your 12th Marksheet (if any)Choose FileNo file chosenDelete uploaded fileUpload 12th/Intermediate marksheet (if any). Supported format - .pdg only. Maximum file size - 200 kb.Upload your sponsorship letter *Choose FileNo file chosenDelete uploaded fileUpload your sponsorship letter. Supported format - pdf only. Maximum file size - 200 kb.Click below to pay Pay NowTransaction ID *Please enter correct transaction id to avoid candidatureship cancellationConsent of information *I have read and understood all the terms and conditions before applying for GNM (General Nursing and MidWifery) course at School of Nursing, The Duncan Hospital, Raxaul. Information provided above are true and correct to the best of my knowledge and i am fully liable of disqualification / cancellation of my candidature-ship at any stage of this course.  Submit Print Form