COLLEGE OF NURSING
CHRISTIAN MEDICAL COLLEGE, VELLORE – 632 004, INDIA.
PERSONAL DATA FORM 2025 - 2026
[Link]. Degree in Nursing 2025
(To be filled in by the candidate in her own handwriting)
To be returned to the Registrar, College of Nursing, CMC, Ida Scudder Road, Vellore – 632 004 so as to reach
on or before 6th June 2025.
Application No.
1. Name (in block letters as entered in school records)
Miss
2. Address
State Pin code
Telephone No. E-mail ______
3. Place of Birth : _____________________
4. a) Nationality : b) Date of birth : c) Age : ______
5. Religion : Christian / Hindu / Muslim / Others (specify)
If Christian, State the Church denomination
6. Scheduled caste / Scheduled tribe / Backward class / Other Community :
7. Marital Status : Single / Married :
8. a) Pattern of schooling : HSE/CBSE/ISC/PDC/PUC/INTERMEDIATE/OTHERS [specify]
b) Name & place of the school :
9. Year of passing the qualifying examination :
10. Number of attempts taken to pass + 2 : First / Second / Third
11. a) Subjects studied in +2 : 11. b) Aggregate percentage (Physics, Chemistry,
Biology / Botany & Zoology)
[Link]. Subjects % of marks
1.
2.
3.
4.
5.
6.
12. Medium of instruction in +2 :
13. Educational qualification other than the qualifying examination (if any) :
14. Are you a graduate? If yes, indicate the main subject and
the year of passing :
15. Are you enrolled in any course of study now? If yes, specify :
16. Have you ever been enrolled as a student in any School /
College of Nursing? If yes, mention the Institution & the year :
17. Are you enrolled currently as a student in any School or
College of Nursing? If yes, name the Institution :
18. Have you ever been selected for any course in CMC, Vellore?
If yes, give the reason for not joining or discontinuing the course :
19. Are you called to attend interview for any other courses in CMC Vellore
this academic year? If yes, mention the course(s) :
20. a) If your sibling has applied for [Link]. Nursing this year in
College of Nursing, CMC Vellore, mention the sibling’s H.T. Number :
b) State if your sibling has been called for the Interview? : Yes / No
c) If yes, is she sponsored : Yes / No
d) If yes, state the Minority Church / Organization :
21. Have you been receiving any scholarship from the Government
or Private bodies for your education? If yes, name the source :
22. Name & address of the guardian (If both the parents are not alive) :
Pin Code
23. (i) State fully from which source you expect to receive financial support for your study in this institution:
Parent / Guardian / Others (Specify)
(ii) I Parent / Guardian of
declare that I shall meet the expenses of the applicant while she is a student in the College of Nursing,
Christian Medical College, Ida Scudder Road, Vellore.
Signature of the Parent / Guardian
Name of the Parent / Guardian
24. Give the following details:
Name Age Qualification Occupation Institution working Monthly Income
Father
Mother
Name Age Qualification Occupation Institution working Monthly Married /
income Single
Brothers
Sisters
25. State the total annual income from all sources:
26. DECLARATION:
We declare that the information given in the form is correct and hereby agree to abide by the rules of the
institution.
Signature of the Candidate
Signature of Parent / Guardian
Place:
Date: P.T.O.
27. Write briefly your life history in the space given below (Include factors which have favourably or adversely
influenced your life and ambitions for the future)
I declare the information given above is correct.
Signature of the Candidate.
Name of the Candidate.