Application for Admission to Register
First Name*
Parent/Guardian Name*
Date of Birth*
Phone No*
Permanent Address*
Course Name*  
Educational Qualification*
Period Of Training*
DU Number*
Last Name*
Marital Status*
Present Address*
Attach Photo
Where Trained*
Examination Council/
University Name*
DU Date*
Particulars regarding registration with CGNRC of Raipur or with any Other council
S.NoNursing ProgrammeName of Nurses Council Where Previously RegisteredRegistration NumberRegistration Date
1 Auxiliary Nurse & Midwife ( A.N.M )
2 General Nursing & Midwifery ( G.N.M. )
3 Bachelor of Science (Nursing) ( B.Sc.(N) )
4 Post Basic BSc ( PB BSc )
5 Master of Science (Nursing) ( M.Sc. )