AMITY UNIVERSITY, JHARKHAND

Amity University Campus, Niwaranpur, Main Road, Ranchi, Jharkhand

FORMAT : B/24 - F/2 @ MENTEES DETAILS @ KNOW YOUR STUDENT (KYS) :

Sr. No. ------------ Date.-……………..

Bactch : ………………, Name of the Institute:- …………………………………, Prog. - …………..………, Sem.- ……, .

A. GENERAL INFORMATION AFFIX

1. Name of the Student : -----------------------------------------------; Gender- ------------ ; Blood Group :…….. LATEST
PHOTO
2. Date of Birth : --------------------------------------------------------; Age: Year-…….& Month- ……..;
(not to staple)
3. Caste : ----------------------------------.;Category : ---------------; Domicile:-----------------------------------

4. Address : Present Permanent/ Parents’ POSTAL Address

House No. ---------; Street : ---------------------------------------;
Ward----------------- Mohalla : ------------------------------------
Town/City : --------------------------; Tehsil-----------------------
Thana. :--------------------------------, Distt:- ----------------------
State : :----------------------------------, PIN:- ----------------------
House No. ---------; Street : --------------------------------------;
Ward----------------- Mohalla : -----------------------------------
Town/City : -----------------------; Tehsil-------------------------
Thana. :--------------------------------, Distt:- ---------------------
State : :---------------------------------, PIN:- ---------------------

5. FAMILY MEMBERS – Total Members - ………………….; Brothers - ………..…., Sisters ……………..Others : …………

6. HOSTEL Details - ( if not residing in above address)- ………………………………………………………….…………..

7. TRANSP. : Public Transport – (y/n)…………… , Own Vehicle – Bike / Car …… , Number ……………
8. Contact & Profession Father Mother Local Guardian
Name
Mobile No
Office
Email Id
If service – Post
Department Name
Place of posting
If Business – goods type
Place of business
If Profession (viz – Adv,
Doctor, consultancy…..
If Occupation (Agri. , Real
Estate, Contractor)
Place
Annual Income
(Gross), In lacs (approx)

B. ACADEMIC (BACK GROUND & PROGRESS ) TRACK INFORMATION

10 12 Dip 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th
Class Grad.
th th .(if) Sem Sem Sem Sem Sem Sem Sem Sem Sem Sem
Year

%
SGPA x x x x
CGPA

Signature of Student Signature of Parent’s/Guardian

Name………………………… Date:-……………. Name…………………………

Signature of the MENTOR Signature of the Prog.Lead. Signature of the Prog.Co

Name………………………… Name…………………………
Name…………………………