amity form

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APPLICATION INSTRUCTIONS
Dear Applicant, You are important to us. We have exceptionally high standards for the talent that we take in our programmes. Superior leadership qualities, communication and interpersonal skills, commitment, problem-solving ability, value driven mindset, professionalism, flexibility, motivation and sharp intellectual curiosity are expected. Please read the instructions in the Application Form-2011, carefully before you begin to fill your Application. The Application form has to be filled in your own clear and legible handwriting and the undertaking is to be signed by you only. This Application form is valid for the Amity University - Uttar Pradesh, Campuses in Noida and Lucknow, Amity UniversityRajasthan, Campus in Jaipur & Amity University Haryana, Campus in Gurgaon (Manesar) . • For all details relating to Eligibility, Fee structure and Procedure for Admission to MBA programmes, kindly refer to the list of MBA programmes (www.amity.edu). • Duly filled in Application Form together with a DD of Rs. 1,100/- in favour of “Amity Form” payable at New Delhi should be submitted/sent to the respective campus you are applying to :
Noida Campus

Lucknow Campus Amity Admission Office Viraj Khand-5, Gomti Nagar Scheme Admission Helpline

Jaipur Campus Amity Admission Office Amity House, 14 Gopal Bari Admission Helpline

For Gurgaon (Manesar) Campus Amity Admission Office Amity International School Campus Admission Helpline Tel.: 0124-3225651

Amity Admission Office Sector-125 Admission Helpline Tel.: 0120-2445252

Noida-201 303 (Adj. New Delhi) Lucknow-226 010 (UP)

Ajmer Road, Jaipur-302006, (Rajasthan) Sector-46, Gurgaon (Haryana)

Tel.: 1800-1800-999, 0522-6525676 Tel.: 1800-1800-111, 0141-2372489

• Visit www.amity.edu/admission for all information relating to your application & admission after submission of application form. • Qualifying candidates can select their date for On Campus Admission Process at www.amity.edu/admission. It is your responsibility to check the website for selection of date and appear in the Admission Process accordingly. No separate communication will be sent in this regard. • You are advised to keep a photocopy of the complete application form. • Incorrectly filled, incomplete, unsigned forms & forms received after due date will be rejected. • Forms once rejected will not be reconsidered & form cost will not be refunded. • You cannot apply more than once for the same programme in one admission year. • Do not attach any Marksheets / Testimonials with the Application Form at this stage. University / Board / Marks filled in the Application Form will be considered for all procedures related to admission. Any discrepancy found during original document verification will result in cancellation of Admission. • Amity does not take any responsibility for delay or loss of the material in post/transit.

We do not accept any donations for admission. Merit is the only criteria. Any instances found, even at a later date, will lead to cancellation of admission.

AMITY UNIVERSITY
Application Form Number

APPLICATION FORM-2011

Form No : 1697443 Password : wtlztm

INSTRUCTIONS
1. 2. 3. 4. 5. Please read the instructions in the Admission Prospectus-2011 before filling up this form. Use BLACK BALL POINT PEN in boxes using English capital letters or English numerals. Do not make any stray marks on this sheet. Do not staple, pin, wrinkle, scribble, tear, wet or fold this sheet. Write in CAPITAL LETTERS only within the box without touching the lines as shown in the Sample below.

1697443

0 1 2 3 4 5 6 7 8 9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

1. NAME OF THE CANDIDATE (as in high school or equivalent certificate)

S

A

R

V

E

S

H

S

H

A

R

M

A

2. MOTHER'S NAME (as in high school or equivalent certificate)

3. FATHER'S NAME (as in high school or equivalent certificate)

4. PHYSICAL STANDARD Height ft. inch. Weight kg.

5. GENDER Male Female

6. CATEGORY GEN SC ST

7. NATIONALITY

Indian

Others

If Other please specify OBC 9. DATE OF BIRTH Date Month Year 8. PROGRAM APPLYING FOR (You may be offered option 2 in case you do not qualify for option 1
Choose option 2 from list of programs under same eligibility.)

Program Code Option -1

Program Code

1

0

0

1

9

Option -2

0

7

0

3

1

9

9

0

(Refer Admission Prospectus-2011 for program code)

10. ADMISSION CATEGORY (Refer admission prospectus for Fee) Non-Sponsored Sponsored Company Sponsored NRI Foreign

11. HOSTEL ACCOMMODATION Yes No If "YES" AC Non AC

12. PREQUALIFYING TEST (For MBA Programs) CAT (For B Arch Program) Date of Test Roll/ID # Score Percentile NATA

13. CONTACT NUMBERS MAT GMAT STD Code Telephone No.

D D M M Y Y Y Y
Country Code Mobile No.

.
_ T H E G

+

9

1

9

7

3

6

1

2

0

0

5

1

14. MANDATORY E-MAIL ADDRESS (Only in Capital Letters)

S

A

R

V

E

S

H

A

M

E

@ Y

A

H

O

O

.

C

O

.

I

N

15. Write your complete Correspondence address including your name in English in Capital Letters with Black Pen. (For all communication including letter of admission)
17. PHOTOGRAPH

Name : Address :
16. SIGNATURE OF THE CANDIDATE (Within the Box only)

Write Application form number & Name at the back of a recent colour Photograph (only on white background) (size : 3.5x4.5 Cm) & paste (do not staple).

City : PIN :

State :

(Within the Box Only)

Do Not Attest

1

18. EDUCATIONAL QUALIFICATIONS
It is mandatory to fill all details of educational qualification (as applicable) from class X onwards till last completed semester/year. If the system of marking of your school/college is on grading pattern, convert grade into marks as applicable and fill in the respective columns. In absence of complete information form will be rejected.

Class X

CBSE

BOARD ICSE NIOS

PASSING YEAR OTHERS

MARKS OBTAINED

MAXIMUM MARKS

XII CLASS XII SUBJECT MARKS DETAILS SUBJECT NAME MARKS OBTAINED GRADE MAXIMUM MARKS (FOR INT. BOARDS)

Name of School :

City :

Board Roll No.

GRADUATION DETAILS Name of Degree

Years Attended From: Duration of Degree Year Months

To: Semester / Year Wise Marks SEMESTER / YEAR 1 2 MARKS OBTAINED

University Enrollment No. MAXIMUM MARKS SGPA*/AGPA* OBTAINED NO. OF BACK PAPER(S) (NOT CLEARED)

SCHEME OF EXAMINATION SEM. ANNUAL

. . . . . . . . . .
2
*Grade point scale used

DISCIPLINE COMMERCE ENGINEERING MANAGEMENT SCIENCE OTHERS

3 4

5 6

7 MODE OF STUDY 8 FULL TIME PART TIME CORRESPONDENCE 9 10

Application Form No. Name of College (Graduation)

City

Name of University (Graduation)

POST GRADUATION DETAILS Name of Degree University Duration of Program Years Attended Marks Obtained Yr 1 Fm :_________ Yr 2 Yr 3 To :__________ Total 19. AWARDS / ACHIEVEMENTS if any (Latest two with proof) Name Received when For what 20. PREVIOUSLY APPLIED: Have you previously applied to Amity? Program Year Were you Selected? 21. PROFESSIONAL COURSES Institution Course Full / Part Time Dates Attended Qualification Given Yes No Yes No Maximum Marks

22. EMPLOYMENT HISTORY (if applicable) Work Experience? Yes No If "Yes", total years of work Years Months City : Tel. : Last Designation: Last Salary Drawn: Details of current / last job Organisation Name : Address of Organisation :

Full-Time Dates : From To Part-Time

23. ADDITIONAL INFORMATION 1. 2. 24. FAMILY INFORMATION Age Father Mother EMAIL ADDRESS OF PARENTS (Only in Capital Letters) Qualification Profession Organisation Designation

3

25. FAMILY AT AMITY Have any of your family members studied / worked with Amity? If, studied, Name If, worked, Name What is the relation to you 26. CORRESPONDENCE ADDRESS (Same as point 15) Address : Yes Program Institution No Year Year

City :

State :

Pin Code :

27. WRITE YOUR COMPLETE PERMANENT ADDRESS (If different from correspondence address)

Address :

City : State : Pin Code :

Do you suffer from any Chronic ailment : Yes

No

If yes give details :

Have you ever been suspended, dismissed or put on academic probation or warning at any school or college ? If "Yes" please explain on a separate sheet of paper. 28. Details of Payment of Form BY CASH Cash Receipt No. BY Demand Draft DD No. THROUGH ONLINE Online Transaction No. 29. SIGNATURE Receipt No. Date : Bank : Date : Yes No

I hereby certify that the information given in the Application (all relevant Forms) is complete and accurate. I understand and agree that misrepresentation or omission of facts will justify the denial of admission, the cancellation of admission, or expulsion. I have read and do hereby consent to the Terms & Conditions for Admission as mentioned in Admission Prospectus 2011.

Signature :

Date :

4

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