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
