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-2012, 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) & Amity University - Madhya Pradesh, Campus in Gwalior For all details relating to Eligibility, Fee structure and Procedure for Admission, kindly refer to the list of programmes (www.amity.edu) Duly filled in Application Form together with a DD of Rs. 1,100/- (if not paid online) 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 Jaipur Campus : Amity Admission Office, Sector-125, Noida-201 303 (Adj. New Delhi) Admission Helpline Tel.: 0120-2445252 / 4713600 : Amity Admission Office, Viraj Khand-5, Gomti Nagar Scheme, Lucknow-226 010 (UP) Admission Helpline Tel.: 1800-1800-999, 0522-6525675-77 : Amity Admission Office, Amity House, 14 Gopal Bari, Ajmer Road, Jaipur-302006, (Rajasthan) Admission Helpline Tel.: 0141-2372489 / 2374595

Gurgaon (Manesar) Campus : Amity Admission Office, Amity International School Campus, Sector-46, Gurgaon (Haryana) Admission Helpline Tel.: 0124-2337015 / 16 Gwalior Campus : Amity University, Madhya Pradesh, Maharajpura (Opposite Airport), Gwalior-474 005 (MP) Admission Helpline Tel.: 0751-3290666 / 3290667

Visit www.amity.edu (Admission Microsite Login) for all information relating to your application & admission after submission of application form. Qualifying candidates can select their date for Admission Process at www.amity.edu (Admission Microsite Login). 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 (Only Foreign students / Foreign University Degree holder should attach photocopies of academic transcripts & AIU Equivalence Certificate). 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-2012

Form No : 5008885 Password : pmetmg

5008885
1. NAME OF THE CANDIDATE (as in high school or equivalent certificate)

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

3. FATHER'S NAME (as in your 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

Option -2

(Refer Admission Prospectus-2012 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.

.
A R U N 2

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

@ G

15. Write your complete Correspondence address including your name in English in Capital Letters with Black Pen. (For all communication including letter of admission) Name : Address :
16. SIGNATURE OF THE CANDIDATE (Within the Box only)

17. PHOTOGRAPH

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

18. EDUCATIONAL QUALIFICATIONS

Class X

CBSE

BOARD ICSE NIOS

PASSING YEAR OTHERS

TOTAL OF MARKS / CGPA OBTAINED

TOTAL OF MAXIMUM MARKS / CGPA

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

Name of School :

Board Name

Board Roll No.

GRADUATION DETAILS Name of Degree

Branch / Subject of specialization (If any)

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) (If not cleared till date)

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 1. Yr 1 Fm :_________ Yr 2 Yr 3 To :__________ Total 2. Fm :_________ Yr 1 Yr 2 Yr 3 To :__________ Total 19. PROFESSIONAL COURSES (other than degree) Institution Course Full / Part Time Dates Attended Qualification Given University Duration of Program Years Attended Marks Obtained Maximum Marks

20. AWARDS / ACHIEVEMENTS if any (Latest two with proof) Name Received when For what

21. PREVIOUSLY APPLIED: Have you previously applied to Amity? Program Year Were you Selected? Yes No Yes No

22. EMPLOYMENT HISTORY (if applicable)

Details of current / last job Organisation Name : Address of Organisation : Months City : Tel. : Last Designation: Last Salary Drawn:

Yes No
If "Yes", total years of work

Years

Full-Time Dates : From

To

Part-Time

Organisation

Designation

24. 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 25. CORRESPONDENCE ADDRESS (Same as point 15) Address : Yes Program Institution No Year Year

City :

State :

Pin Code :

26. 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. 27. Details of Payment of Form BY CASH Cash Receipt No. BY Demand Draft DD No. THROUGH ONLINE Online Transaction No. 28. SIGNATURE Bank : Date : Yes No

201201292203254

Receipt No.

66273

Date :

29/01/2012

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 2012.

Signature :

Date :