3 & 4 Kabiguru Sarani, City Centre, Durgapur - 713216 Tel : (0343)2569890, 7384885508, e-mail : [email protected] Website : www.amikinstitute.org
To The Director AMIK INSTITUTE OF MANAGMENT SCIENCES AND TECHNOLOGY City centre, Durgapur - 713216, Burdwan, West Bengal
This form duly filled in, with documents wherever necessary, should be submitted on or before............................................ *Incomplete forms will not be entertained
Sir/Madam,
I hereby apply for admission in BSW(H)/MSW at AMIK for the session 2020 to 2021
.
Date : 07/11/2024
1. Course
: BSW MSW
2. Name(in block letters)
:
3. Father's Name/Guardian's Name/Husband's Name
4. Gender
: Male Female Trans
5. Date of Birth (enclose supporting document)
6. Nationality
7. Present Address (mailing address)
: : : : :
8. Whether SC/ST/Physically Handicapped
(attach attested copy of certificates)
9. Statement of marks obtained at different examinations (Attach attested copies of mark sheets)
10. Any other Information
11. Name of the Insttution Last Attended
12. Registration No. of the Board
Council/University lasr attended
I do hereby declare that information provided in this form is true to the best of knowledge and belief.
Date: 07/11/2024
Place:
Full Signature of the Applicant