The document is a student enrollment form for an academic session at Amity University. It collects personal information about the student such as name, date of birth, contact details, educational qualifications, and a signed undertaking. The student agrees to abide by the university's rules and understands their admission can be cancelled if any information is suppressed or distorted. The form is then verified and signed by the head of the study center before the student is enrolled with a generated enrollment number.

1. Student Enrolment Form
Academic session……………………….. Space for passport
size photograph
Application Status
Program Name
(To be accompanied
Program Code by a govt. issued
photo ID)
Full Name of Student Mr. Last Name Middle Name First Name
(in Block Letters) Ms.
Father’s / Husband Name Last Name Middle Name First Name
Nationality _______________________ State of Domicile ______________________
Date of Birth Date Month Year
Sex Male Female
E-mail Address
Contact Number __________________________
Correspondence Address ___________________________________________
___________________________________________
___________________________________________
Name of School/ Year of Board/ College/ Main Subject Aggregate of
Educational University Passing University Marks
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

2. Educational Name and Address of Organization Designation From To
Qualifications
(including 12 yrs
of formal
schooling)
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