RAJASTHAN NURSING COUNCIL
JAIPUR
B-29, Sardar Patel Marg, C-Scheme, Jaipur, Ph-0141-2222923
(FORM II)
Second Year Examination in General Nursing and Midwifery course – 3 Year Course (this Application
must reach the Registrar of the Rajasthan Nursing Council, Jaipur on or before the……………..)
APPLICATION
Institution Name…………………………………………………………………………………………………………………..
Fresh Repeater/Supplementary
Recent Passport Size
To Color Photograph
The Registrar, duly attested by the
Rajasthan Nursing Council, Principal
Jaipur
PARTICULARS TO BE FILLED IN BY THE CANDIDATE
1. Candidate Name :-………..…………………………………………………………………………………………
2. Father’s Name :-………..…………………………………………………………………………………………
3. Mother’s Name :-………..…………………………………………………………………………………………
4. Age & Date of Birth :-……….. Years (DD)……………../ (MM)……………/ (YY)………………
5. Current Address :-.…………………………………………………………………………………………………..
6. Permanent Address :-…………………………………………………………………………………………………...
7. Date of passing the previous examination [with Roll No.] :-.……………………………………………………………
8. Language in which the candidate wishes to be examined Hindi English
I Mr./Ms. (Name of candidate in Block Letters Same as per Secondary Mark-sheet) ………………………………
…………………………………………………………….S/o/ D/o …….……………..……………………………………………
request permission to present myself at the ensuing SECOND YEAR Examination for General Nursing Midwifery
Course.
The Fee Rs………………….is forwarded herewith.
Dated……………………….
Yours Obediently,
(Candidate Signature)
PARTICULARS TO BE FILLED IN BY THE INSTITUTION
1. Date of admission to the Institution :-…………………………………………………………….
2. Record of leave taken with kind of leave & Date :-SL…... VL……..Others…….. Total………
3. Period of Training with No. of Lectures attend in each subjects.
Subject Total No. of Lectures No. of Lectures Attended Percentage of
Lectures Attended
1. Medical Surgical Nursing - I
2. Medical Surgical Nursing - II
[Link] Health Nursing
[Link] Health Nursing
4. Details of previous Examination(s)
Name of Examination Year Roll No. Result Marks Remarks
GNM First Year
5. Subject offered for Main Examination:-
Papers Remarks
1201 – Theory - Medical Surgical Nursing - I
1202 – Theory - Medical Surgical Nursing - II
1203 – Theory - Mental Health Nursing
1204 – Theory - Child Health Nursing
1205 – Practical - Medical Surgical Nursing
1206 – Practical – Child Health Nursing
1207 – Practical – Mental Health Nursing
(Only School Exam, No Council/Board Exam)
Note: If any candidate fails in theory paper either in Medical Surgical Nursing – I or Medical Surgical Nursing – II then
candidate has to re-appear in both theory (i.e. Medical Surgical Nursing-I & II) paper and practical if he/she fails in
either theory or practical paper.
6. Conduct
7. Health
8. Ward work
9. General Capacity
SIGNATURE OF NURSING TUTOR SIGNATURE OF THE PRINCIPAL
CERTIFICATE
I certify that Mr./Ms…………………………….……………………………………………………………………….
S/o/D/o………………………………………………………………………………………………………………. has fulfilled
the requirement contemplated under the prescribed regulation, in my opinion his/her education, character, conduct &
training to perform the duties of a nurse. His/Her age on the month of examination will be to the best of my
information & belief ………..Year……..Month……….Day.
I further Certify that he/she attended at least 80% of the lectures & demonstration.
Date: Signature & Seal of Principal
NB:-
1. Eligibility admission to the exam may be assessed as per instruction in syllabus and Regulations of I.N.C. Only
applications of those candidates must be sent who are eligible.
2. Incomplete or late applications without specific reasons will not be entertained.
3. Please attach |a| 10th Mark-sheet /Certificate |b| GNM First Year/Second Year Mark-sheet(s) (if any).
