Program Name

Program Code

Name of School/ University

Year of Passing

Board/ College/ University

Main Subject Aggregate of Marks

Space for passport

size photograph

(To be accompanied

by a govt. issued

photo ID)

E-mail Address Contact Number __________________________ Correspondence Address ___________________________________________ ___________________________________________

___________________________________________

Student Enrolment Form

Academic session………………………..

Application Status

Full Name of Student

(in Block Letters)

Mr. Last Name Middle Name First Name

Ms.

Nationality _______________________ State of Domicile ______________________

Date of Birth Date Month Year

Sex Male Female

Father’s / Husband Name

Educational

Qualifications

(including 12 yrs

of formal

schooling)

Amity Center for e-Learning (ACeL), F-2 Block, Second Floor, Sector 125 Campus, NOIDA 201303 (UP), INDIA

Last Name Middle Name First Name

Name and Address of Organization Designation From To

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 Center)

Office Seal Name/ Designation______________

For Use by office

Student Enrolled/Not Enrolled

Enrollment No. Attended

Amity Center for e-Learning (ACeL), F-2 Block, Second Floor, Sector 125 Campus, NOIDA 201303 (UP), INDIA

E-mail: mssharma@amity.edu

Educational

Qualifications

(including 12 yrs

of formal

schooling)