Professional Documents
Culture Documents
Registration/Enrolment Form
FOR OFFICE USE ONLY
Registration No. .
Receipt No. ..
Fees Deposited:
Cash/Cheque (Details):
APPLICATION INFORMATION
1. Name (Use CAPITAL Letters)
2. Date for Birth Age as on: ..Yrs.
3. Gender:
Male
Female
4. Fathers Name ..
5. Fathers Profession..
6. Full Address: Permanent: .
..Pin.
Ph: ..Mob.
Ph: ..Mob. ..
7. Educational Qualification:
Examination
Name of
school
Board/Univ.
Year of
% age
Subject
passing
Class VIII
Class IX
Class X
Class XI
Class XII
8. Mention the year in which you had completed your last examination: .
9. Have you appeared in the IIT/JEE Examination earlier? If yes, Give details:
10.Are you:
Student
Employed
Self-Employed
Date:
Signature ..
N.B.: 1. The decision taken by the Academy on your above application for admission shall be
final and binding.
2.
Fee once paid will neither refund nor adjust under any circumstances.