RESIDENTIAL COACHING ACADEMY
Aligarh Muslim University
Session 2012 - 2013
Application Form for Admission to Communication Skills Programme
1. Name (in block letters):
2. Father's Name:
Affix Passport
Size recent
Photograph
3. Correspondence Address / Hall of Residence:
4. Phone No.: Email ID:
5. Mobile No.:
6. Name ofthe Hall:
7. Educational Qualifications (from High School onwards):
S.No. Examination Board/Univ. Year Subjects %age Division
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2.
3.
4.
5.
8. Have you received coaching at Residential Coaching Academy, AMU earlier? YesD NoD
Ifyes,.give details: Reg. No.: ____ Year: ____ Exam: ____ Course: ___
9. Have you received coaching in any other coaching institutes? YesD NoD
If yes, please mention the name of the institution & year: Institution: ..................................................... Year: ................ Exam/Course: ...............
10. Declaration
I, hereby solemnly affirm that I have neither been involved in any criminal case nor any criminal case is pending against me in any court of law. I have not been debarred/rusticated by the institution last attended/presently attending. I, ___________ hereby solemnly declare on oath that the entries made by me in the above columns are true to the best of my knowledge and belief and if at any time, the entries are found incorrect, the admission may outrightly be cancelled and disciplinary action may be initiated against me.
D ate: -------- Thumb impression of the candidate,
Male (L Tl), Female (RTI)
Signature ofthe candidate
Signature of Provost of the Hall
concerned with Stamp