Registration Form - Regional Institute of Nursing

Course & Personal Information

Course Applied for

Candidate Name

Father Name

Mother Name

Local Guardian's Name

Nationality

Date of Birth *

Contact Information

Village/Road

Post Office

District

State

Email

Mobile

Academic Records

Qualifying Examination	Name of Board	Year of Passing	Total Marks	Total Marks Obtained	Percentage of marks (%)

Document Upload

Passport Size Photo

12th Marksheet

Payment Details

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Application Fee: Rs. 1000

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Application fee once paid will not be refunded under any circumstances.

Transaction ID Please enter the transaction ID after making the payment

Declaration

I hereby declare that all the information provided by me in this application is true and correct to the best of my knowledge and belief. I understand that providing any false information or suppression of any factual information would render me liable to debarment from admission or removal from the institute if already admitted.

Admission Registration Form 2026-27