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Amity University Enrollment Form

This document contains a registration and enrollment form for the Directorate of Distance & Online Education at Amity University. The 3-page form collects personal information from prospective students such as name, contact details, educational history, employment history, program of interest, and a signature agreeing to abide by university rules. It also includes spaces for a photo, signature of the head of the study center verifying the information, and a section for the office to note admission payment and enrollment status.

Uploaded by

Atupele Mwampashi
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226 views2 pages

Amity University Enrollment Form

This document contains a registration and enrollment form for the Directorate of Distance & Online Education at Amity University. The 3-page form collects personal information from prospective students such as name, contact details, educational history, employment history, program of interest, and a signature agreeing to abide by university rules. It also includes spaces for a photo, signature of the head of the study center verifying the information, and a section for the office to note admission payment and enrollment status.

Uploaded by

Atupele Mwampashi
Copyright
© © All Rights Reserved
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

DIRECTORATE OF DISTANCE &

ONLINE EDUCATION

Registration cum Enrolment Form


Space for passport
size photograph
Academic session……………… (To be accompanied
by a govt. issued
photo ID)

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: Mother's Name:


(As per School Certificate) (As per School Certificate)

Nationality: State of Domicile:

Date of Birth: Sex: Male Female


Date Month Year

E-mail Address: Contact No.:

Correspondence Address:

Source of Information: Web Search Friends Recommendation Newspaper Visual Add

Any other source

Employment History: Name & Address of the Organization Designation From To


(For last 5 years, If applicable)

Educational Qualifications: Name of Year of Board/ College/ Main Subject Aggregate of


(including 12 yrs of formal schooling) School/ University Passing University Marks

Amity Directorate of Distance & Online Education, F-2 Block, Second Floor, Sector 125 Campus, NOIDA 201303 (UP), INDIA

Contact No.: 0120 4735650 / 889


DIRECTORATE OF DISTANCE &
ONLINE EDUCATION

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

Admission Fee ( _______________ ) paid via Demand Draft/Online no. ________________ Dated______________
payable at NOIDA.

Date:

Place:

(Signature)

Student Enrolled/Not Enrolled

Enrollment No. Attended:

Amity Directorate of Distance & Online Education, F-2 Block, Second Floor, Sector 125 Campus, NOIDA 201303 (UP), INDIA

Contact No.: 0120 4735650 / 889

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