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Student Application Form

Lincoln Global Academy

Postal Address :
54, Rajendra Nath Chatterjee Road
Kolkata – 700035, India

Telephone : +918017559717

Email : [email protected]

Website : www.lincolnglobalaca.com

Checklist

All sections of the form completed

Completed and signed declaration page

*Please note typed or printed names will not be accepted. Lincoln Global Academy (LGA) accepts only handwritten signatures.

* Certified copies of original documents are required.

Privacy : Your personal information is collected on this form to assess your application for enrolment into LGA. LGA may contact your previous education provider to verify information provided in this form. If your application is successful, the information you provide will be used for selection and process your enrolment in LGA.

General Instructions

Before you proceed to fill the application form please ensure that you have read and understood the eligibility criteria for the PROGRAMME you are applying for.
Meeting the eligibility criteria is mandatory to get admission to LGA.
Please select the Programme you wish to seek admission to. Only ONE program can be selected per application form. If you wish to apply for more than one program, use separate application forms.
Please fill the application form only in ENGLISH, unless it is specified to write in any other language.
Application form needs to be completed. If any field/s do not apply to you, mark as N/A.
Please be careful in filling up the information in all aspects. Incomplete form will not be accepted.
Any error/misinformation in the application form shall result in cancellation.
Candidate should fill his / her basic details like Date of Birth (DOB), Address, State, City, Country, Contact / Mobile Numbers and Email very carefully.
Enter your First name/ Middle name/Family name in the space provided. The name should be same as mentioned in the Class X/XII/School leaving certificate.
Important updates on the admission process will be available on the website.
Before final submission of application form, read the declaration carefully and give your consent on it, failing which your application will remain incomplete.
Once submitted no changes/modifications will be possible for the information provided. No communication shall be entertained in this regard.
Any admission related query/grievance should be addressed to the following e-mail id: [email protected]
Applicants are advised to read the application form carefully and keep ready the digital or scanned copy of all the documents in pdf format for uploading.

1. Student Information

FIRST NAME

Please enter your First Name.

LAST NAME

Please enter your Last Name.

DATE OF BIRTH

Please enter your Date of Birth.

EMAIL ID

Please enter your valid e-mail.

MOBILE NUMBER

Please enter your valid mobile no.

GENDER

Male

Female

Please choose your Gender.

ADDRESS

Please enter your Address.

CITY

Please enter your City.

PIN CODE

Please enter your Pin Code.

STATE

Please enter your State.

COUNTRY

Please choose your Country.

HOBBIES

Please enter your Hobbies.

QUALIFICATION

SL. NO.	EXAMINATION	BOARD	PERCENTAGE	YEAR OF PASSING
1
2
3
4
5
6
7

PROGRAMME APPLIED FOR

Please select programme

2. Parent/Legal Custodian details
Parent/Legal Custodian 1

FULL NAME

Please enter Full Name.

MOBILE NUMBER

Please enter valid Mobile no.

HOME PHONE (If applicable)

Please enter valid Phone no.

EMAIL ID

Please enter valid e-mail.

HOME ADDRESS (If different to student details above)

Please enter Address.

RELATIONSHIP TO STUDENT

Please enter Relationship to student.

Parent/Legal Custodian 2

FULL NAME

Please enter Full Name.

MOBILE NUMBER

Please enter valid Mobile no.

HOME PHONE (If applicable)

Please enter valid Phone no.

EMAIL ID

Please enter valid e-mail.

HOME ADDRESS (If different to student details above)

Please enter Address.

RELATIONSHIP TO STUDENT

Please enter Relationship to student.

3. Alternate contact details (to be used if the parents/legal custodians are not contactable)

FULL NAME

Please enter Full Name.

MOBILE NUMBER

Please enter valid Mobile no.

HOME PHONE (If applicable)

Please enter valid Phone no.

EMAIL ID

Please enter valid e-mail.

HOME ADDRESS (If different to student details above)

Please enter Address.

RELATIONSHIP TO STUDENT

Please enter Relationship to student.

RELATIONSHIP TO STUDENT’S MOTHER/ FATHER/ LEGAL CUSTODIAN

Please enter Relationship to student’s Mother/ Father/ Legal custodian.

Declaration, acknowledgement and consent

I declare that the information given in this application form is complete, true and correct.
I understand that providing false or misleading information, or non-disclosure of relevant information, may result in cancellation of the student’s enrolment.
I agree that if any of the information on this form changes, I will provide updated information to LGA as soon as possible and within 7 days.

Upload Student’s Signature

Please upload Student’s Signature.

Upload Parent/legal custodian signature

Please upload Parent/legal custodian signature.