AMITY UNIVERSITY
UTTAR PRADESH
Amity Center for e-Learning...
Student Enrolment Form
Space for passport
size photograph
(To be accompanied
by a govt. issued
photo ID)
Academic session………………
Program Name:
Program Code:
Full Name of Student:
Mr.
(In Block Letters as per School Certificates)
Mrs.
Last Name
Middle Name
First Name
Father's Name:
(As per School Certificate)
Nationality:
State of Domicile:
Sex:
Date of Birth:
Date
Month
Male
Female
Year
E-mail Address:
Contact No.:
Correspondence Address:
Source of Information:
Web Search
Employment History:
(For last 5 years, If applicable)
Educational Qualifications:
(including 12 yrs of formal schooling)
Friends Recommendation
Name & Address of the Organization
Name of
School/ University
Year of
Passing
Designation
Board/ College/
University
Newspaper
Visual Add
From
Main Subject
Amity Center for e-Learning (ACeL), F-2 Block, Second Floor, Sector 125 Campus, NOIDA 201303 (UP), INDIA
Contact No.: 01204392786 / 889
To
Aggregate of
Marks
AMITY UNIVERSITY
U T TA R
PRADESH
Amity Center for e-Learning...
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)
Name / Designation
Office Seal
For Use by Office
Admission Fee ( _______________ ) paid via Demand Draft/Online no. ________________ Dated______________
payable at NOIDA.
Date:
Place:
(Signature)
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
Contact No.: 01204392786 / 889