Admission Form

IIT-ians PROFESSIONAL ACADEMY FOR COMPETITIVE EXAMINATIONS

Date of Admission: ID No:

IIT & MEDICAL

Course Applied For : Foundation Builder:

Regular Three year Integrated Andheri BPJC

VII Vacation Dadar DPJC KC

VIII

IX

Thane NPJC Podar PPJC Jankidevi School New Horizon School (Panvel) Correspondence TPJC

Two years Integrated

APJC HFS

Ratanbai Walbai

New Horizon School (Airoli) Repeater (Dropper)

Two year Normal

Crash Course & Test Series

CENTRE PREFERRED SAT / TOEFL

ANDHERI POWAI SAT

BORIVALI THANE TOEFL

CHEMBUR KHARGHAR SAT + TOEFL

DADAR ULHASNAGAR

NERUL KALYAN

Name of the Candidate:

Father's /Guardian's Name:

Occupation: Office Address:

Personal Details
Designation: Designation:

Mother's /Guardian's Name:

Occupation: Office Address: Date of Birth (Student): Nationality: Name of School: SSC Other (Please Specify): CBSE Board Affiliated to: ICSE PCM /PCB (%) Obtained in the last School exam / Board Examination : Achievements (KVPY / NTSE / Olympiads / School or Class Rank / Board Topper / Others) Residential Address :

Contact Details
Pin Code: Student's Mobile No. Father's Mobile No. Mother's Mobile No. (Parent): NEET BITSAT OLYMPIAD MEDICAL AIPMT Year of Examination :

Phone (Res.) Phone (Off.) E-mail ID (Student) Which Competitive Exam(s) Do You Plan To Take? JEE MAIN Others: JEE ADVANCED

"Could You Share With Us The Name Of A Teacher Who Has Specially Influenced / Motivated / Generated Interest In You To Take Future Studies In Sciences" Name Of Teacher: Subject Name: Name of School / Coaching Class: Feedback About The Teacher: Address:

Rules & Regulations

1 All information are true and correct. 2 If a student is not working hard, creating indiscipline, irregular to the class, not

responding properly, he/she may be expelled from the Institute. The decision of the Managing Director in this regard will be final and binding on the student. No fee will be refunded in such cases.
3 After depositing the course fee, if a student becomes disinterested due to any reason

whatsoever the course fee is non-refundable under any circumstances.

4 It is for student himself/herself to see whether he/she is eligible for a certain

examination or not; Institute doesn't hold itself responsible if a student's admission form cannot be forwarded to or is rejected by the concerned examination body for any reason, whatsoever.
5 Incomplete forms will be rejected. It is compulsory to attach a photocopy of mark sheet

of class IX / X & passport size photograph to the admission form. The Institute reserves the right to use the photograph for publicity in case the student secures position/success in JEE/NEET, MEDICAL, SAT, AIPMT, HSC & Science Olympiad or any other Exam. The student should also staple two extra photographs with the form.
6 Any change of address and telephone number should be notified to the office without

delay.
7 IIT-ians PACE IIT & MEDICAL reserves its right to make any alteration in its program or

fee without any prior notice to anybody.

8 In case of any dispute, the decision of the Managing Director of PACE is final and

binding on all faculty members, students & business associates. All disputes are subject to jurisdiction of Mumbai.

Parent's

Students Signature

For Office Use:

Photo Manual ACF

Mark Sheet

Tally Receipt

Agam Receipt

Agam ACF

Any Other Documents

Receivers Full Name (In capital letters)

Name of the Centre Received