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1 Dow University of Health Sciences, Karachi APPLICATION FORM for ADMISSION IN MASTERS IN NURSING SCIENCE (MNS) SESSION 2011 at Institute of Nursing Application No. (AP No.) Note: Candidates are advised to fill the application form completely. Please read carefully the instructions for candidates, attached with the form. Fill the Form in BLOCK LETTERS with BLACK PEN. Photograph Name of Applicant S/o, D/o Date of Birth Place of Birth Age on closing date Female Male Education details: DETAILS Matric Inter Science Nursing School B.S Nursing Date of Passing Name and address of Institution Total Marks Obtained Pakistan Nursing Council Certificate Expiry Date: Place of Domicile: Place of practical experience: Time period of work experience: CNIC No. Candidate: CNIC No. Father / Mother / Guardian:

2 1. Matric Certificate attached... Yes No 2. Matric Mark sheet attached... Yes No 3. Nursing Diploma (In case of Post RN BSc Program)... Yes No 4. Mark Sheets of Nursing School... Yes No 5. Inter Science Certificate (In case of BSc Nursing) attached... Yes No 6. Inter Science Mark sheet (In case of BSc Nursing) attached... Yes No 7. B.S Nursing Certificate... Yes No 8. B.S Nursing Mark Sheets... Yes No 9. Pay order for entrance test... Yes No 10. Candidates domicile of 11. Candidates PRC of 12. Candidates Permanent address on CNIC NADRA / B Form 13. Father s domicile of 14. Father s Parmanent address as on CNIC NADRA address of Candidate of Father Present address Permanent address (as on CNIC) Contact Nos. of Candidate of Father any other Relative Tel. No. Cell No. Signature of father/guardian Signature of the Applicant DATE OF SUBMISSION D M Y

3 CERTIFICATE FROM PRINCIPAL OF SCHOOL (LAST ATTENDED) This is to certify that Mr. / Miss Son / daughter of Mr. was a student of this school having been admitted into class from till Name of School Address of School Name of Student and Father s Name Permanent Address Date of Birth Last Examination Passed (a) (b) Seat No. Enrolment No (c) Total Marks obtained / Maximum Marks (d) Division / Grade obtained Percentage Obtained It is further certified that during his/her period of stay his/her conduct & character was Place Date SIGNATURE OF THE PRINCIPAL WITH SEAL

4 CERTIFICATE FROM PRINCIPAL OF NURSING SCHOOL (LAST ATTENDED) This is to certify that Mr. / Miss Son / daughter of Mr. was a student of this school having been admitted into class from till Name of Nursing School Address of Nursing School 1) Name of Students and Father s Name 2) Present address 3) Permanent Address 4) Last examination passed a. Date of Passing College Registration No. b. Marks Marks Obtained Max Marks (i) First Year (ii) Second Year (iii) Third Year c. Division / Grade Total Marks Obtained / Maximum Marks d. No. of attempts in which passed e. Whether received any warning or punishment during the time when he/she was student of the college, if so give details It is further certified that during his/her period of stay in this college his/her work, conduct & character was Place Date SIGNATURE OF THE PRINCIPAL WITH SEAL

5 Particulars of Father/Mother/ Guardian 1. Name 2. Occupation 3. Designation 4. Place of work 5. Name of organization 6. Office Address 7. Present Residential Address 8. Permanent Address 9. address 10. Office Phone Mobile Phone 11. Res. Phone 12. Any Other Contact Number 13. Annual Income 14. Religion 15. Nationality 16. NADRA NIC No. 17. Domicile District Date of Issuance NOTE: If father is working abroad. These particulars must be endorsed by Pakistan embassy / consulate of the respective country. Signature of father

6 Fill all boxes with your present address Phone No (Res.): Phone No (Off.): Mobile No. : Phone No (Res.): Phone No (Off.): Mobile No. : Phone No (Res.): Phone No (Off.): Mobile No. : Phone No (Res.): Phone No (Off.): Mobile No. : 4

7 IMPORTANT INSTRUCTIONS FOR CANDIDATES 1. Candidates are advised to read the prospectus carefully for admission to the Institute of Nursing of Dow University of Health Sciences for session 2011, before submitting the application form. 2. Fill all the columns of application form in BLOCK LETTERS with BLACK PEN. 3. Be sure to tick the appropriate Box in the application form.. 4. Photocopies of all required documents must be attested by Govt. officer, grade 18 and above. 5. Photocopy of the application form and incomplete form will be rejected. 6. No form will be accepted in any case after the last date and time of the application form. 7. Each application for admission should be accompanied by Non Refundable Entrance Test Fee of Rs. 1500/- (Rupees One Thousand Only) in the form of pay-order or demand draft in the favour of Dow University of Health Science, (DUHS). 8. Carefully check the Required Documents list mentioned in the prospectus before submitting the application form. 9. Specimen of undertaking will be given when the candidate is declared eligible for provisional admission. 10. The application form and required documents completed in all respect should be submitted to United Bank Limited, Baba-e-Urdu Road, Branch, Karachi. 11. If any eligible candidate has not received the admit card 48 hrs prior to the entrance test, he/she should contact DUHS help desk, mentioned in the Prospectus. 12. In case, their is any change in the date of Entrance test due to some unavoidable situation, it will be notified on the website of DUHS DO NOT submit the original documents alongwith the application form. 14. All queries should be sent on address mentioned on the Back page. 15. No candidate should contact personally for any queries. 17. Daily visit the website of DUHS for announcement and informations. Note: DO NOT attach this page with your application form. 6

8 Dow University of Health Sciences, Karachi. Father s Postal Address: ADMIT CARD FOR ENTRY TEST OF ADMISSIONS IN MS NURSING Session 2011 at Institute of Nursing Candidate s Copy Roll No. Please Paste (1 x 1) Photograph Tel No: Mobile No: E.mail: Signature of Candidate Date: For Official Use Left Hand Thumb Impression of Candidate Time: Venue: Note: See Instructions Overleaf Signature Seal Father s Postal Address: Dow University of Health Sciences, Karachi. ADMIT CARD FOR ENTRY TEST OF ADMISSIONS IN MS NURSING Session 2011 at Institute of Nursing DUHS Copy Roll No. Please Paste (1 x 1) Photograph Tel No: Mobile No: E.mail: Date: For Official Use Signature of Candidate Left Hand Thumb Impression of Candidate Time: Venue: Signature Seal

9 INSTRUCTION FOR THE CANDIDATE 1. If there is any change regarding Entry Test, venue or timings, it will be mentioned on DUHS website. 2. Carefully read instructions for attempting test paper, otherwise computer will not read your answers. 3. Candidate must bring this Admit Card for the test, on the date, time and venue given overleaf. 4. CANDIDATE WILL NOT BE ALLOWED TO APPEAR IN THE TEST WITHOUT THIS ADMIT CARD. 5. No Identification other than this Admit Card will be acceptable. 6. Impersonation for the Entrance test will be considered as a criminal case and will be dealt seriously. 7. Candidate is required to reach the venue at least two (02) hours before the test (i.e. by 8:00 A.M). 8. Any material or electronic device / mobile phone / calculator etc, will not be allowed, under any circumstances. 9. If any student is found, using unfair means or cheating he will be debarred from the test and admission.

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