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Admission Form

This document contains an application form for admission to Amity University's distance learning and online programs. It requests information such as the applicant's name, date of birth, nationality, contact details, educational qualifications, employment history, program of study, and includes undertakings to be signed. It also contains payment details and sections for office use regarding enrollment status and number.

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jainash25
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47 views

Admission Form

This document contains an application form for admission to Amity University's distance learning and online programs. It requests information such as the applicant's name, date of birth, nationality, contact details, educational qualifications, employment history, program of study, and includes undertakings to be signed. It also contains payment details and sections for office use regarding enrollment status and number.

Uploaded by

jainash25
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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^^^^^^^^^^^^^^^

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U T TA R P R A D E S H ^^^^^^^^^^^^^^^

U T TA R P R A D E S H ^^^^^^^^^^^^^^^
AMITY UNIVERSITY ---------UTTAR PRADESH---------

ISO 9001 : 2000 Certified

Academic Session.. Applying for (Tick One) Course Applied for Application Status Full Name of Student (In Block Letters) Father's / Husbands Name Mr. Ms. Mrs. Last Name Middle Name Online Programme Distance Learning Programme

Space for Photograph (Passport Size) Attested by Head of Study Centre


First Name

Last Name

Middle Name

First Name

Nationality Date of Birth Date

State Of Domicile Month Year

Sex E-mail Address: Contact number: Correspondence Address

Male

Female

Source of Information

Web search (AMITY/ACeL) Web search (GOLS l Academy Website) Associate Sales Partners - GOLS l Academy Visual Advt.
Name & Address of Organisation Designation

Anyother source, please specify Friends recommendation Newspaper Advertisement


From To

Employment History (For Last 5 Years, If applicable)

Educational Qualification

Name & Address of Organisation

Name of School/University

Year of Passing

Board/College/University

Main Subject

Aggregate % of Marks

Amity Centre for eLearning (ACeL) Amity Centre for eLearning (ACeL) F-2 - BLock,- SecondAmity Campus, Sec - 44, NOIDA (UP), India. (UP) INDIA. PIN: 201303 J Block, Floor, Sector 125 Campus, NOIDA. 201 303 PIN: 201303 E-mail: [email protected] E-mail: [email protected]

^^^^^^^^^^^^^^^

^^^^^^^^^^^^^^^

U T TA R P R A D E S H ^^^^^^^^^^^^^^^

U T TA R P R A D E S H ^^^^^^^^^^^^^^^

www.gols.in

ISO 9001 : 2000 Certified

Undertaking: I Solemnly affirm that the above information made and furnished by me is true and correct. Further, I am being admitted to the above stated programme entirely on my request and I agree to abide by all the rules and regulations of Amity University. In the event of suppression or distortion of any fact like educational qualifications, nationality, etc, made in the Enrollment Form, I understand that my admission is liable for cancellation. Date : ____________________ Place: ____________________ (Signature of Student) ...............................................................................................................................................

Particulars Verified
Signature : _______________________________ (Head of the Study Centre)

Office Seal

Name/Designation _______________________

...............................................................................................................................................

For Use By Office


Admission Fee (Rs. 11750/8200/14000/13000/- Paid Vide Cash/Online/DD/Chq No: ______________ Dated ____________________of_____________________ Bank) payable at Delhi / Noida.

Date: _________________ Place: _________________

Signature

............................................................................................................................................... Student Enrolled/Not Enrolled Enrollment No. Allotted

Amity Centre for eLearning (ACeL) Amity Centre for eLearning (ACeL) F-2 - BLock,- SecondAmity Campus, Sec - 44, NOIDA (UP), India. (UP) INDIA. PIN: 201303 J Block, Floor, Sector 125 Campus, NOIDA. 201 303 PIN: 201303 E-mail: [email protected] E-mail: [email protected]

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