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    SAM Global University

    Enrollment Form 2024-2025


    To,
    The Registrar
    SAM Global University, Raisen
    Sir,
    Giving the following details , I request you to please Enroll me in the Your University and also
    communicate the allotmentEnrollment Number: I have read all the rules regulations and ordinances relevant
    to me and I promise to abide by them . I also promise to obey

    Student Name : AMIT PATIDAR Gender : Male


    Father’s Name: : GULAB CHAND DOB : 01-Jan-1998

    Mother’s Name: : SHUKAN BAI Category : OBC

    Date of Admission : 27-Nov-2024 Religion : HINDU


    Name of the College/ Institute Being Admitted : Agricultural Science

    Name of the Board/ University:


    Qualification Name of Degree Board / University Passing Obtain Marks Percentage
    Year / Total Marks / CGPA
    Govt High school baghuniya Mp board 2013 383 / 600 63.83/
    10th

    12th Saraswati h s school ,Shamgarh Mp board 2015 307 / 500 61.40/


    ,mandsaur
    UG Mahatma Gandhi chitrakoot Mahatma Gandhi chitrakoot gramoday 2021 12468 / 18100 68.88 /
    gramoday Vishwavidyalaya Vishwavidyalaya
    PG

    Name of Course in Which Admitted: Master of Science (Agriculture) Branch : M.Sc Agriculture Horticulture
    Mode of Admission : (Vegetable Science)

    Name of the Board / University last attended with year : Mahatma Gandhi chitrakoot gramoday Vishwavidyalaya
    Migration Certificate No. :
    Permanent Address :

    Address MAKAN NO- 27 WARD NO- 04 TEH- SHAMGARH DIST MANDSOUR BAGHUNIYA

    City Mandsaur Tehsil Shamgarh

    District Mandsaur State Madhya Pradesh

    Pincode 458883

    Date :27-Nov-2024 Signature

    Certified that the above student has been admitted to this institution through procedure as laid down by the
    Govt. of Madhya Pradesh and the entires above have been checked and verified by me from the records.
    Therefore I recommend that he/she should be enrolled as requested by the student.

    Date :27-Nov-2024

    Signature of the
    Head of the Department with seal

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