Registration Form Preferred College Name(Required)KRISHNA INSTITUTE OF HIGHER EDUCATION, PATNAKRISHNA INSTITUTE OF PARAMEDICAL SCIENCES, PURNEAVIDYAPATI INSTITUTE OF HIGHER EDUCATION, SAMASTIPURKRISHNA INSTITUTE OF NURSING AND PARA MEDICAL SCIENCES, SAMASTIPURKRISHNA INSTITUTE OF HIGHER EDUCATION, MADHEPURAKRISHNA INSTITUTE OF IT & MANAGEMENTKRISHNA INSTITUTE TECHNOLOGYSOUMYA KRISHNA ANM TRAINING SCHOOLStudent Image(Required)Max. file size: 1 MB.Abailable course in KRISHNA INSTITUTE OF HIGHER EDUCATION-Patna(Required)Bachelor of PhysiotherapyBachelor of Hospital ManagementBachelor of Occupational TherapyBachelor of Medicala Laboratory TechnologyDiploma in Operation Theatre AssistantDiploma in Medical Laboratory TechnicianCertificate in Medical DresserAvailable course in Krishna Institute of Paramedical Sciences, Purnea(Required)Bachelor of Physiotherapy (BPT)Bachelor of Hospital ManagementAvailable Course in VIHE, Samastipur(Required)Bachelor of PhysiotherapyBachelor of Hospital Management (BHM)Bachelor of Occupational TherapyBachelor of Medicala Laboratory TechnologyDiploma in Operation Theatre AssistantDiploma in Opthalmic AssistantDiploma in Medical Laboratory TechnicianDiploma in E.C.GCertificate in Medical DresserANMGNMAvailable Course in KINPS, Samastipur(Required)ANMGNMB.Sc. NursingPost Basic B.Sc. NursingBachelor of PhysiotherapyBachelor of Occupational TherapyBachelor of Hospital ManagementB. PharmD. PharmDiploma in Operation Theatre AssistantDiploma in Medical Laboratory TechnicianCertificate in Medical DresserAvailable Course in KIHE, Madhepura(Required)Bachelor of Physiotherapy (BPT)Bachelor of Hospital Management (BHM)Diploma in Medical Laboratory TechnicianCertificate in Medical DresserB.Sc. NursingANMGNMAvailable Course in Krishna Institute Technology(Required)Bachelor of Computer Application (BCA)Bachelor of Business AdministrationBA (Journalism & Mass Communication)MBAMBA (MARKETING MANAGEMENT)MBA (FINANCE)MCACIVIL ENGINEERINGCOMPUTER SCIENCE AND ENGINEERINGELECTRONIC ENGINEERINGMECHENICAL ENGINEERINGARTIFICIAL INTELLIGENCEAvailable Course in Krishna Institute of IT & Management(Required)Bachelor of Computer Application (BCA)Bachelor of Business AdministrationBA (Journalism & Mass Communication)Available Course in Soumya Krishna ANM Training School(Required)ANMFull Name of the Applicant(Required)Father’s Name(Required)Mother’s Name(Required)NationalityDate of Birth(Required) DD slash MM slash YYYY SexMaleFemaleCategoryGeneralEWSOBCEBCSCSTAadhar No.Migration No.Migration Issue Date DD slash MM slash YYYY Complete Correspondence Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Mobile No-1(Required)Mobile No-2Email ID(Required) Complete Permanent Address : Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Matric Board NameIntermediate Board NameIntermediate Appearing Board NameOther Board NameMatric Passing YearIntermediate Passing YearIntermediate Appearing Passing YearOther Passing YearSubject in MatricSubject in InterSubject in Intermediate AppearingSubject in OtherMarks % in MatricMarks % in InterMarks % in Intermediate AppearingMarks % in OtherDivision in MatricDivision in InterDivision in InterDivision in OtherEnclosed xerox copy of 10th and 12th(Required) Marksheet Certificate S.L.C./ C.L.C Provisional Certificate Aadhar Migration certificate must be attached Original. Source of Information for this Entrance Examination(Required)Declaration I hereby declare that the application form has been filled in my own handwriting and that information furnished there in are correct. I shall a bide by the rule and regulations of the Institute and will obey the orders given by the authorities with regard to my conduct.PlaceDate MM slash DD slash YYYY Candidate Signature in HindiMax. file size: 1 MB.Candidate Signature in EnglishMax. file size: 1 MB.Parent’s/ Guardian’s SignatureMax. file size: 1 MB.
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