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REGISTRATION FORM
Registration No.:
(for official use only)

Test Date:

Affix
passport size
coloured
photograph

Choose Your Test and Study Centre: (Tick Any One)

Test centre
South Delhi

Gurgaon

North-West Delhi

East Delhi

Gurgaon

North-west Delhi

East Delhi

II

Study centre
South Delhi

PROGRAMME OPTION
Two-Year Classroom Programme: 2012
ETYCP (X Appearing)

TYCP (X Appearing)

CTYCP (X Appearing)

One-Year Classroom Programme: 2011

OYCP (XII Studying)

EOYCP (XII Pass)

OYCP (XII Pass)

COYCP (XII Pass)

Foundation Courses
Foundation I (X studying)

Foundation II (IX studying)

Foundation III (VIII studying)

Batch option: (if applicable)

(Write your preference by marking 1, 2, 3)

Regular

Weekend

Name:.........................................................................................................................................D.O.B. /. /.
Fathers/Guardians name:........................................................................................................................................................
Address: House no..........................................................................Street................................................................................
Area...........................................................................................................................................................................................
City..................................................................................................State..........................................
Pin code...................................Ph. no.....................................................Mobile.......................................................................
E-mail Id : .......................................................................................................Class studying /passed ....................................
Percentage of marks obtained in last exam (PCM / Sc.+Maths Aggregate).............................................................................
Name and address of the school attending/attended.........................
..................................................................................................................................................................................................

How did you come to know about Narayana IIT Academy?

[Tick/fill in the appropriate choice(s)]

a)

From Narayanas leaflet/brochure taken from..........................................................................................

b)

From advertisement (please specify the newspaper)...............................................................................

c)

From posters/banner at............................................................................................................................

d)

From present/ex-Narayana student Name:..............................................................................................

e)

Other medium (please specify)................................................................................................................

Registration procedure
Submit your application form along with two passport-size colour photographs, a photocopy of the marksheet
of your last examination and Rs 1000/- as registration fee (Rs 500/- for Foundation Courses) for the
admission-cum-scholarship test by cash or by demand draft drawn in favour of Narayana IIT Academy,
payable at New Delhi.
Registration form can be deposited at any of the following centres:

NARAYANA IIT ACADEMY

South Delhi Centre
: 47-B, Kalu Sarai, New Delhi - 110016 Ph: 42707070,46080612
Gurgaon Centre (Extn. Centre of Kalu Sarai) : M-21, Old DLF Colony, Sector-14, Gurgaon Ph.: 0124-3217791/92
North-West Delhi Centre : 15, Central Market, West Punjabi Bagh, New Delhi - 26 Ph.: 45062651/52/53
East Delhi Centre
: 32-E, Patparganj Village, Mayur Vihar Phase-I, Delhi-110091 Ph.: 43061644/45
Dwarka Centre
: 317/318, Vikas Surya Galaxy, Main Market, Sector4, Dwarka, N.Delhi 75 Ph.: 45621724/25

I/We hereby declare that all the details stated above in this registration form are true to the best of my/our
knowledge and believe and I/we promise to abide by the rules and regulations of the Narayana IIT Academy.

(Signature of Student)
Date:
Place:

Note 1: Registration fee is non-refundable.

Note 2: All disputes are subject to Delhi jurisdiction

(Signature of Parent/Guardian)