Admission Form – Amulaya Institute

Applied Course in Institute*

Subject

ChemistryPhysicsMathsBiology

Student Name*

Date of Birth*

Contact Number*

Email Id*

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School Name*

School Area

District*

State

Country

Pin Code

School Admission Status*

Regular ModeDistance Mode

Class*

Section

Academic Performance*: (Last Pass out Class Record Only)

Class

Passing Year

Board

Subjects	Obtained Marks	Total Marks	Percentage	Grade

Father's Name*

Father's Occupation*

Department*

Contact No*

Email Id*

Mother's Name*

Mother's Occupation

Department

Contact No

Email Id

Correspondence Address

Guardian Name*

Contact Number*

House Number*

Colony/Apartment*

Area*

District*

State*

Country

Permanent Address

House Number*

Colony/Apartment*

Area*

District*

State*

Country

Signature of Father / Guardian*

Student’s Signature*

Rules & Regulation

Declare that I have read rules and regulation mentioned prospectus of the institute. I agree to abide by the rules given in prospectus and form.

AgreeDisagree