REGISTRATION FORM - Narayana IIT Academy
REGISTRATION FORM - Narayana IIT Academy
REGISTRATION FORM - Narayana IIT Academy
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<strong>REGISTRATION</strong> <strong>FORM</strong><br />
NARAYANA<br />
<strong>IIT</strong>/ PMT ACADEMY<br />
Registration No.:<br />
(for official use only)<br />
Affix<br />
passport size<br />
coloured<br />
photograph<br />
Test Date:<br />
Course Options<br />
<strong>IIT</strong>-JEE<br />
PMT<br />
Programme Options<br />
One-year classroom programme: 2014<br />
OYCP (XII Studying) IOYCP (XII Pass) EOYCP (XII Pass)<br />
Two-year classroom programme: 2015<br />
ETYCP (XI Studying)<br />
One Year Foundation Courses<br />
Foundation – I (VIII Studying) Foundation – II (IX Studying) Foundation – III (X Studying)<br />
Batch option: (if applicable) (Write your preference by Marking 1 & 2)<br />
Regular<br />
Weekend<br />
Name: ......................................................................................................................... D.O.B……. /……./………….<br />
Father’s/Guardian’s name: .....................................................................................................................................<br />
Address: House No. ......................................................... Street................................................................................<br />
Area ....................................................................................................... City ...........................................................<br />
State…………………………….......................................... …………….Pin code............................................................<br />
STD Code: .................................Ph. No................................................Mobile..............................................................<br />
E-mail …………………………………………...................................................................................................................<br />
Class studying /passed ...................................................................…………………………………………………….<br />
Percentage/Grade of marks obtained in last exam .................................................................................................<br />
Name and address of the school attending/attended ........………………………………………………………………...<br />
………………………………………………………………..……………………………………………………………..........
How did you come to know about <strong>Narayana</strong> <strong>IIT</strong> & PMT <strong>Academy</strong>?<br />
[Tick/fill in the appropriate choice(s)]<br />
a) From <strong>Narayana</strong>’s leaflet/brochure taken from .............................................................................................<br />
b) From advertisement (please specify the newspaper) ..................................................................................<br />
c) From posters/banner at ..............................................................................................................................<br />
d) From present/ex-<strong>Narayana</strong> student:............................................................................................................<br />
e) Other medium (please specify) ...................................................................................................................<br />
Registration procedure<br />
Submit your application form along with two passport-size colour photographs, a photocopy of the marksheet of<br />
your last examination and registration fee for the admission-cum-scholarship test by cash or by demand draft<br />
drawn in favour of “<strong>Narayana</strong> Learning Pvt. Ltd.” payable at New Delhi.<br />
INSTRUCTIONS:<br />
Note 1*<br />
Specified reason & merit of the student in the Admission Test will be considered by the management<br />
while allotting the Regular / weekend batch option.<br />
Note 2<br />
Note 3<br />
Registration fee is non-refundable.<br />
All disputes are subject to Delhi jurisdiction.<br />
DECLARATION<br />
I/We hereby declare that all the details stated above in this registration form are true to the best of my/our<br />
knowledge and I/we promise to abide by the rules and regulations of the NARAYANA <strong>IIT</strong>/PMT <strong>Academy</strong>.<br />
(Signature of Student)<br />
(Signature of Parent/Guardian)<br />
Date :<br />
Place :<br />
NARAYANA <strong>IIT</strong>/PMT ACADEMY<br />
47-B, Kalu Sarai, New Delhi – 110016 Ph: 011 – 42707070, 42707000
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