Scribd Logo
Upload

Welcome to Scribd!

  • 88 views

    Fiitjee Form For DLP

    Uploaded by

    keshav
    This document is an enrollment form for correspondence programs provided by FIITJEE. It requests information from the student such as name, date of birth, address, education details, preferred test center for exams, and payment details. The form also lists the various programs being offered for different grades and their respective last dates for application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Fiitjee Form For DLP

    Uploaded by

    keshav
    88 views4 pages
    This document is an enrollment form for correspondence programs provided by FIITJEE. It requests information from the student such as name, date of birth, address, education details, preferred test center for exams, and payment details. The form also lists the various programs being offered for different grades and their respective last dates for application.

    Original Description:

    its fiitjee form to apply for the DLP

    Original Title

    Fiitjee Form for DLP

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document is an enrollment form for correspondence programs provided by FIITJEE. It requests information from the student such as name, date of birth, address, education details, preferred test center for exams, and payment details. The form also lists the various programs being offered for different grades and their respective last dates for application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    88 views4 pages

    Fiitjee Form For DLP

    Uploaded by

    keshav
    This document is an enrollment form for correspondence programs provided by FIITJEE. It requests information from the student such as name, date of birth, address, education details, preferred test center for exams, and payment details. The form also lists the various programs being offered for different grades and their respective last dates for application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    ENROLMENT FORM

    Correspondence Programs

    Enrolment No. :
    (For official use only)

    (To be filled by the student)


    Please Affix Your
    Recent Passport Size
    Colour Photograph

    Name of Program Enrolling for :


    (for list of Programs see page no. 4)

    Preference of Test Centre


    for AITS for JEE (Main & Advanced) :
    (for list of Test Centres see page no. 3)

    Name of the Student

    Fathers/Guardians Name :
    Mothers Name

    Date of Birth

    Nationality :

    Correspondence Address :

    Pin :
    Ph. (Res.) with STD Code :
    Permanent Address

    Mobile No. ** :

    Pin :
    Ph. (Res.) with STD Code :

    Mobile No. :

    School affiliated to

    CBSE

    Class

    IX

    Science+Math/PCM (%) :

    X Board

    Marks (if in Grades)

    X Board- Science

    Category of Student

    General

    ICSE

    Other (Please Specify) _____________________________

    X
    .

    XI
    %

    XII
    XII Board

    XII (Pass)
    .

    Maths

    XII Board- P

    Other (Please specify) ____________________________

    E-mail ID of the Student :


    (in Block Letters)

    ** Please mention if you want to receive information through SMS on this mobile:

    Yes

    No

    FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110 016, Ph: 011- 46106068 / 64 / 10 / 13 / 15
    All India Toll Free No. 1800 11 4242, E-mail: [email protected], website: www.fiitjee.com
    1/4

    Nearest relative / Guardian Address (to be contacted in case the student is not available at the above mentioned address):

    Pin :
    Ph. (Res.) with STD Code :

    Name of the School

    Mobile No. :

    (studying or passed)

    Name of the Principal

    School Address

    Pin :
    Phone No.:

    Details about your Parents:

    Particulars

    Father

    Mother

    Name
    Qualification
    Occupation
    Designation
    Company Name
    Company / Office Address

    Company / Office Tel. No.


    Mobile No.
    E-mail (in Block Letters)
    Annual Income

    FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110 016, Ph: 011- 46106068 / 64 / 10 / 13 / 15
    All India Toll Free No. 1800 11 4242, E-mail: [email protected], website: www.fiitjee.com
    2/4

    Test Centres$ for All India Test Series (AITS) for JEE (Main & Advanced) (only one centre can be opted):
    Delhi (South), Delhi (North-West), Delhi (East), Delhi (Dwarka), Delhi NCR (Faridabad), Delhi NCR (Ghaziabad), Delhi NCR (Gurgaon),
    Delhi NCR (Noida), Agra, Ahmedabad, Ajmer, Allahabad, Amritsar, Aurangabad, Bangalore, Bareilly, Bathinda, Bhagalpur, Bhilai,
    Bhopal, Bhubaneswar, Bokaro, Chandigarh, Chennai, Dehradun, Dhanbad, Durgapur, Gaya, Gorakhpur, Guwahati, Gwalior, Hisar,
    Hyderabad, Indore, Jabalpur, Jaipur, Jammu, Jamshedpur, Jhansi, Jodhpur, Kanpur, Karnal, Kharagpur, Kochi, Kolkata, Kota,
    Lucknow, Ludhiana, Meerut, Mumbai (Andheri), Mumbai (Chembur), Mumbai (Kandivali), Mumbai (Navi Mumbai), Mumbai
    (Thane), Muzaffarpur, Mysore, Nagpur, Patiala, Patna, Pune, Ranchi, Rohtak, Roorkee, Rourkela, Shaktinagar NTPC, Siliguri,
    Thiruvananthapuram, Thrissur, Udaipur, Ujjain, Vadodara, Varanasi, Vijayawada & Visakhapatnam.
    $ Above are the Test Centres for All India Test Series for JEE (Main & Advanced) only.

    Note: All India Test Series (One Year & Two Year) is also available by Correspondence
    (All the Test Papers to be received & attempted at your home.)

    Course Fee payment details :


    Demand Draft No.

    Drawn on Bank

    Dated

    Check List (Please tick in the box):


    1. Photocopy of
    X / XII Board Marksheet*
    VIII school final exam marksheet* (for Junior Rankers Study Material)
    2. Colour Photographs (4 Passport Size)
    3. Demand Draft for Course Fee

    Amount

    * In case of claim for scholarship, marksheet / certificate of Scholastic Achievement is to be attested by the past or present School Principal.

    Note 1:
    Note 2:
    Note 3:
    Note 4:
    Note 5:

    Fee of any program is not refundable at any stage.


    All India Test Series is part of Rankers Study Material. You need not enrol for it separately in case you are enrolling yourself for Rankers Study Material.
    Please write your name behind your Photograph and your name & address behind the Demand Draft.
    The Demand Draft for course fee for all the above mentioned JEE programs should be in favour of "FIITJEE Limited - TS, RTPF, GMP A/c" payable at
    New Delhi.
    Photocopy of this form can also be used.

    Place: ______________
    Date: ______________

    (Signature of the Student)

    (Signature of Parent / Guardian)


    Name _______________________________________________
    Relationship with the Student____________________________
    Mobile. No. of Parent / Guardian _________________________

    FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110 016, Ph: 011- 46106068 / 64 / 10 / 13 / 15
    All India Toll Free No. 1800 11 4242, E-mail: [email protected], website: www.fiitjee.com
    3/4

    For JEE (Main & Advanced), 2015 (for Class XII & XII Pass)
    I am interested in enrolling for (Tick the appropriate box)

    Last date to receive completed application

    Open Test

    7th February, 2015

    Grand Masters Package

    Available from November, 2014

    Rankers Test Papers File

    Available from December, 2014

    For JEE (Main & Advanced), 2016 (for Class XII & XII Pass)
    I am interested in enrolling for (Tick the appropriate box)

    Last date to receive completed application

    Rankers Study Material (One Year Version)

    31st August, 2015

    One Year All India Test Series

    8th November, 2015

    One Year All India Test Series (By Correspondence)

    15th November, 2015

    For JEE (Main & Advanced), 2017 (for Class XI)


    I am interested in enrolling for (Tick the appropriate box)

    Last date to receive completed application

    Rankers Study Material (Two Year Version)

    20th September, 2015

    Two Year Integrated All India Test Series

    29th November, 2015

    Two Year Integrated All India Test Series (By Correspondence)

    6th December, 2015

    For Students of Class X (for Target NTSE, 2015 - 16)


    I am interested in enrolling for (Tick the appropriate box)

    Last date to receive completed application

    FIITJEE All India Open Test Series for Target NTSE 2015 - 16

    30th June, 2015

    Single Test of Target NTSE Test Series (Please mention Test Date)

    One week before Test Date

    For Students of Class IX aspiring to excel in IX, X, Jr. Science Olympiad / Math Olympiad
    & Foundation JEE (Main & Advanced) / KVPY / NTSE / Other Competitive Exams
    I am interested in enrolling for (Tick the appropriate box)

    20th September, 2015

    19112014

    Jr. Rankers Study Material

    Last date to receive completed application

    FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110 016, Ph: 011- 46106068 / 64 / 10 / 13 / 15
    All India Toll Free No. 1800 11 4242, E-mail: [email protected], website: www.fiitjee.com
    4/4

    You might also like