Applications submitted more than once will be rejected
Please fill the application and click on submit button, then you will get a preview screen, in that preview screen at the bottom you will get a button "Print this Form" Please click this button, you will get the print out, in that print out you will get space for sticking Photograph and Thumb impression.

Course Intending to apply M.B.B.S B.D.S B.P.T B.Pharm BSc Nursing
Post Certificate B.Sc Nursing BAMS ALL   *
Candidate Details  
 1. Candidate's Name :(As given in class SSLC/10th Certificate)   * 
 2. Father's/Mother's Name :   * 
 3. Gender : Male  Female       *
 4. Date Of Birth :   * [eg: DD/MM/YYYY] 
 5. Address for Communication:   * 
   
   
 CITY  
 PIN :   * 
 District  
 STATE  
 6. E-Mail :   *
 7. Telephones :  
 STD Code   * 
 Telephone   * 
 Mobile  
 8. Choice Of Centre :   * 
 9. Category :  General Merit BRD  KTC SC (For Karnataka) ST (For Karnataka) * 
 10. Details of Demand Draft :  
 D. D. No.   * 
 Amount in Rs   * 
 Date Of Issue   * [eg: DD/MM/YYYY] 
 Name of Drawee Bank   * 
 Will you download TAT card online ? YES  NO     * 
11. Educational Details :
 Year of Passing SSLC / SSC / 10th :   * 
 Total Max. Marks in SSLC / SSC / 10th :  
 Total Marks Obtained in SSLC / SSC / 10th :  
 12. Appearing for PUCII / HSC / 12th : YES  NO*If appearing this year, Please select YES. Already appeared select NO.
 Year of Passing PUC II / HSSC / 12th :   *  If appearing this year, Please put 2010.
 Total Max. Marks in PUC II / HSSC / 12th :   "Physics, Chemistry & Biology - Total"  PCB / PCM / PC & CS / PCE (Only for B.Pharm)
 Total Marks Obtained in PUC II/ HSSC/12th :   "Physics, Chemistry & Biology"  PCB / PCM / PC & CS / PCE (Only for B.Pharm)
 13. Address of the School :   * 
   
   
 CITY  
 STATE :   * 
 To be filled only by applicants seeking addmission to Post Certificate B.Sc. (Nursing) Course :   
 Final GNM Score:   * 
 Internship completion date :
Should complete by April 04, 2010. 		  * 
 State council registration number :
  * 
 14. Declaration - I
  1. I hereby declare that the above information is true and complete to the best of my knowledge. I am aware that if any information herein is found to be incorrect or incomplete, my application form will be rejected / admission will be cancelled.
  2. If admitted to any of the college of KLE  University, Belgaum I shall abide by its Rules &Regulations.
  3. I have read and understood all the provisions contained in the brochure / website and hereby agree to abide by these provisions. 
  4. I am aware that, any legal matters arising out of the total admission process of any Course through KLEAIET - 2010 will be in the courts of Belgaum.
  5. I will not indulge in any kind of ragging activities.