APPLICATION FOR ENTRANCE TEST

For 11th/12th pass Students Rs. 60/-

www.super30.org
Name in CAPITAL :
Date of Birth : _____/______/_________ Female Male IMPORTANT
DD MM YYYY

Category : GEN OBC SC ST PH

Stick recent
Father's Name : Passport size
photograph
Father's Occupation :

(a) If salaried, Employed with : GOVT. SECTOR PRIVATE SECTOR

(b) Designation :

(c) Name of Office / Company :

Current Address :

Pin Code Telephone No./Mobile No.

EDUCATIONAL INFORMATION
Name of School last attended :

Marks Obtained in : Board Exam (In Percentage) Inter Exam (In Percentage)

Name and Address of Teachers and Coaching Centres that have attended for the preparation of IIT (JEE)
Mathematics :
Physics :

Chemistry :

Write the name of subjects Physics, Chemistry and Mathematics in ascending order according to your interest.

Have you enrolled (or have to be enrolled in future) anywhere in the similar program? If yes, write the name of the programme and institute.

Have you enrolled (or have to be enrolled in future) in any test series? If yes, specify

If you get selected in SUPER 30, would you like to avail the facility of free lodging and food?

Do you need bank's loan for your B.Tech programme?

After completing your B.Tech, what would you like to do–higher studies or job?

(Applicant's Signature)

ADMIT CARD
ENTRANCE TEST IMPORTANT
Ph. : 9135060806, 9135060804, 9135060805
www.super30.org
Stick recent
Name :
Passport size
Roll No. : photograph

Test Date :

Centre :