SSUHS


ENTRANCE EXAMINATION FOR ADMISSION INTO GNM COURSE IN ASSAM (BOTH GOVT./PRIVATE INSTITUTES) FOR THE SESSION - 2025-26

COURSE OPTIONS

Choose Course :
ANM/LHV :	Yes	No

PERSONAL INFORMATION

Name of the Candidate : * ( As per Certificate/Marksheet of HSSLC or equivalent )
Father's Name :
Mother's Name :
Gender :	Male Female
Date of Birth :
Age as on 31st December, 2025 :
Category :	GENERAL	OBC/MOBC	SC	STP	STH
EWS:	Yes	No
TGL:	Yes	No
Ex - TGL :	Yes	No
Char Area :	Yes	No
Are you Physically Handicapped : (Divyang)	Yes	No
Nationality :	Indian	Others
Religion :	Hinduism	Islam	Christianity	Sikhism	Buddhism	Others
Physical Identification Marks :	1.
	2.
Are you a Permanent Resident of Assam? : (Note : PRC is Mandatory for Government Seat)	Yes	No

COMMUNICATION INFORMATION

Local Address :


City :
Pin :
District :
State :
Permanent Address :	As Above



City :
Pin :
District :
State :
STD Code :
Telephone :
WhatsApp Mobile No. :
Email Address :

CENTRE OF EXAMINATION

Choose any one Centre :

Guwahati

Dibrugarh

Silchar

Jorhat

Barpeta

Tezpur

Diphu

Lakhimpur

Kokrajhar

Nagaon

Nalbari

Dhubri

EDUCATION

HSSLC (Passed/ Appearing): Passed Appearing

Choose Education :
10+2 class passed preferably with English
10+2 with English having 40% of marks in vocational ANM course from the schools recognized by Indian Nursing Council.
Registered as ANM with State Nursing Registration Council
State Nursing Registration Council Number :
10+2 with English having 40% of marks in Vocational Stream-Health care Science from a recognized CBSE board/State/Centre

HSSLC EXAMINATION DETAILS

Date of passing HSSLC or Equivalent Examination :
Name of Educational Institution from where passed HSSLC or Equivalent Examination :
Name of Board/Council/University from where passed HSSLC or Equivalent Examination :

AGGREGATE PERCENTAGE

Aggregate Percentage

UPLOAD PHOTO AND SIGNATURE

Instruction For Photograph: => Photograph must be JPG or JPEG format. => Size of photograph must be less than 35 kb. => Height of photograph must be between 250 pixel and 320 pixel. => width of photograph must be between 150 pixel and 220 pixel.
Instruction For Signature: => Signature must be JPG or JPEG format. => Size of signature must be less than 30 kb. => Height of signature must be between 100 pixel and 180 pixel. => width of signature must be between 150 pixel and 220 pixel.

Password :
Re-Enter Password :

DECLARATION BY THE CANDIDATE

I declare that above entries in the Application Form has been filled up by me and the entries made are correct as per my documents and to the best of my knowledge and belief. I agree that if any statement is proved to be false then the Authority shall have the right to take legal action against me for submitting false information or statement. I further declare that there is no allegation of misconduct against me and I have never been convicted for any offence involving moral turpitude.