Course Registration Form

Mercy College of Nursing, Valakom, Kottarakkara, Kollam (Dist) BSc Nursing Application Form 2025-26

Fill out the form carefully for registration of Application
Student Name*

First NameLast Name
Name of Parent/Guardian*

First NameLast Name
Birth Date*

DayMonthYear
Gender*
Religion
Caste
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Local Guardian if any.

Name

Street Address Line 2

CityState / Province

Postal / Zip Code
Catagory*

GeneralSCSTNRIOBCOther
Blood Group
Nationality/Nativity*
Address for Communication*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail*
example@example.com
Phone Number*
Local Guardian Phone No.
Upload Photo of the Applicant*

JPEG, pdf or PNG format less than 2MB
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Educational Marks, Enter marks obtained for the 12th grade only*

Rows	Physics	Chemistry	Biology	English	Board/University
Plus 2 or Equivalent

Upload mark list of qualifying examination.

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Application Fee Payment Method*

Rows Rs 800/-

Bank Transfer
Payment of Rs. 1000/- can be made to the bank account of Mercy College of Nursing at Federal Bank, Valakom. IFSC code:FDRL0001225 A/C No. 12250100138004*

Attach Copy of Bank transfer receipt, this is needed for the application to be complete.
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Write your initials using mouse/input device for signature*

Clear
All details provided in the application are true to the best of my knowledge and ability.
Should be Empty:

Rows	Rs 800/-
Bank Transfer

Mercy College of Nursing, Valakom, Kottarakkara, Kollam (Dist) BSc Nursing Application Form 2025-26