D/D M/M Year. Class : VIII IX X X appeared (going to XI) XII XII appeared / pass. School affiliated to : CBSE ICSE Others (Please Specify)

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1 REGISTRATION FORM Registration No. : (For official use only) Registration Centre : (For official use only) Test Date : Preference of Test Centre : Please Affix Your Recent Passport Size Colour Photograph Preference of Study Centre : Name of the Candidate : Father s/guardian s Name : Date of Birth : Nationality : D/D M/M Year ID of the Student : (where result can be sent) Mobile No. : (for informing result through SMS) Class : VIII IX X X appeared (going to XI) XII XII appeared / pass Name of the School Presently Attending / : Last Attended School Address : Pin Code : Ph. No. :, School affiliated to : CBSE ICSE Others (Please Specify) Aggregate Marks (%) obtained in the last School / Board Examination:. % Correspondence Address : (where result can be sent) Pin : Ph. (Res.) : Mobile No. : Ph: , , Fax: website: 1/6

2 Permanent Residential Address : Pin : Ph. (Res.): Mobile No.: ID of Local Guardian : Hostel Required : Yes No Please fill in the following information : FATHER MOTHER Name (In Block Letters) Academic Qualifications Designation Name of Organization Office Address Telephone No. (Off.) Mobile No. (for informing result through SMS) ID (where result can be sent) How did you come to know about Classroom Programs? Fill in the appropriate choice(s). a) From present/ex- ian Name: Program: b) From FIITJEE s brochure taken from c) From newspaper advertisement (please specify the newspaper) d) From posters / banners e) Other mode (Please specify) Are you ready to be focused & get the best from Guidance? Ph: , , Fax: website: 2/6

3 Please tick program for which you want to register: PROGRAMS for IIT-JEE, 2012 Simultaneous preparation for X & XII Boards, Olympiads & SAT Two Year Integrated School Program (Target IIT-JEE / Medical / Competitive Entrance Exams -2012) Two Year Integrated School Program for IIT-JEE, 2010 For students appearing / appeared in X board & going to XI PINNACLE Program prepares a student for IIT-JEE, Other Engineering Entrance Exams, International Olympiads, SAT & Excellence in Boards One Year Classroom Program for NTSE, 2008 For students of VIII Target NTSE Program prepares a student for NTSE (National Talent Search Examination) and gives a strong reasoning ability & increased IQ Two Year Classroom Program (Target IIT-JEE / Medical / Competitive Entrance Exams -2012) One Year Classroom Program (Target IIT-JEE / Medical / Competitive Entrance Exams -2011) For students of X ASCENT Programs prepares a student for Excellence in Boards + NTSE, Olympiads & a strong Foundation for IIT-JEE / Medical / Competitive Entrance Exams for IIT-JEE, 2012 TWO YEAR CLASSROOM PROGRAM Synchronized study of Boards + IIT-JEE + AIEEE for IIT-JEE, 2010 For students appearing / appeared in X board & going to XI ONE YEAR CLASSROOM PROGRAM For students of XII For XII appeared / pass students Mark Your Preference (1, 2, 3, 4 or X) SUPREME - Four Year Integrated School Program Four Year Classroom Program ASCENT Plus - Two Year Integrated School Program ASCENT - Two Year Classroom Program For students appearing / appeared in X board & going to XI Mark Your Preference (1, 2 or X) PINNACLE - Two Year Integrated School Program Two Year Classroom Program (The Program that Produces Toppers) Ph: , , Fax: website: itjee.com 3/6

4 ADMISSION TEST DATES TARGET NTSE - One Year Classroom Program for NTSE, 2008 SUPEREME 4 Year Integrated School Program for IIT-JEE, 2012 FOUR YEAR CLASSROOM PROGRAM for IIT-JEE, 2012 ASCENT* One Year Classroom Program Target IIT-JEE / Medical Entrance / Competitive Exams ASCENT Plus Two Year Integrated School Program Target IIT-JEE / Medical Entrance / Competitive Exams ASCENT Two Year Classroom Program Target IIT-JEE / Medical Entrance / Competitive Exams TWO YEAR CLASSROOM PROGRAM for IIT-JEE, 2010 PINNACLE Two Year Integrated School Program for IIT-JEE, 2010 One Year Extended Classroom Program 30th March, th April, 2008 ONE YEAR* CLASSROOM PROGRAM 30th March, 2008 * On 20th April, 2008 test will be conducted at Mumbai test centres for Mumbai study centre only Test 1-15th June, 2008 Test 2-6th July, 2008 Test 1-1st June, 2008 Test 2-13th July, 2008 Test 1-30th March, 2008 Test 2-6th April, 2008 Test - 20th April, 2008 Phase D Test 1-25th May, 2008 Test 2-1st June, 2008 Phase E Test 1-15th June, 2008 Test 2-13th July, 2008 Test 1-1st June, 2008 Test 2-15th June, 2008 Test 3-6th July, 2008 Test 1-20th April, 2008 Test 2-4th May, 2008 Test - 25th May, 2008 FTRE 4th June, 2008 Test 1-15th June, 2008 Test 2-26th June, 2008 Phase D Test - 20th July, 2008 Admission Test Centres : 1). Registration is open at all FIITJEE Centres viz. Delhi NCR {(South Delhi & Gurgaon ), (Noida ), (North-West Delhi, Janakpuri & Rohini ) & (East Delhi )}, Amritsar ( ), Bangalore ( ), Bhilai ( ), Bhopal ( ), Bokaro (325511), Chandigarh ( ), Chennai {Kilpauk ( ), Adyar ( )}, Hyderabad {Saifabad ( ), Dilshuknagar ( ) & Kukatpally ( )}, Indore ( ), Jaipur ( ), Kolkata {Rabindra Sadan & Ultadanga-Salt Lake ( )}, Lucknow ( ), Mumbai {Dadar, Kandivali, Andheri, Chembur, Navi Mumbai ( )}, Patna ( ), Ranchi ( ), Shaktinagar NTPC ( ), Thane ( ), Visakhapatnam ( ). 2). Admission Tests will also be conducted at the following centres (on the spot registration will commence five days before the test date): 30th March, Hisar, Karnal & Rohtak ( ) ; 6th April, Gorakhpur ( ), Guwahati ( ), Hisar, Karnal & Rohtak ( ) & Meerut ( ). 3). FIITJEE Talent Reward Exam on 4th June, 2008 will also be conducted at Bhagalpur, Bhubneshwar, Gorakhpur, Kanpur, Kota, Pune & Vijayawada. Note 1. Note 2. All the centres are FIITJEE s own centres and not a franchise centre. Please see list of FIITJEE Centres and Program Availability Grid for details. Generally all centres would offer all FIITJEE regular programs. FIITJEE school programs are available at all centres in association with schools. Please see the attached list of FIITJEE Centres and Program Availability Grid for details. FIITJEE has own Senior Secondary School under the name of FIITJEE JUNIOR COLLEGE at Hyderabad. How to Register : Fill in your complete details in this form, mentioning test centre & study centre of your choice alongwith the photocopy of last board / school exam marksheet / school identity card, two passport size colour photographs and Rs. 500/- (Rupees Five Hundred only, inclusive of service tax), {for Target NTSE, SUPREME, FOUR Year & ASCENT programs for students of class VIII, IX or X, the test fee payable is Rs. 300/- (Rupees Three Hundred only, inclusive of service tax)} by Demand Draft (for D/D payment details visit In case of Two Year Classroom Program, if your first choice is Weekend or Sunday Contact Program and in case of One Year Classroom Program if your first choice is Weekend Contact Program you are required to deposit Rs. 1000/- (Rupees One Thousand only) as batch option fee (wherever applicable) alongwith the registration fee, in cash or by Demand Draft / Pay Order (for D/D payment details visit The registration fee & batch option fee can also be paid in cash in person at office. Last Date to Register : In person : One day before the Test Date. By post : Seven days before the Test Date Fee Paid Rs. in Cash / DD / Pay Order No.: Dated Bank Date: Place: (Signature of Student) Note 1: Note 2: Note 3: Note 4: Note 5: Note 6: reserve Once admission is granted to the hostel, students will not be permitted to withdraw during the course of the academic session and no refund will be made during mid session. Registration fee will not be refunded in any case. Once a student joins the study centre offered, (irrespective of his / her choice of study centre before joining) no request for change of study centre will be entertained, nor will the course fee paid be refunded under any circumstances. rese The registered office of Limited is at New Delhi. In case of dispute, students / parents are subject to the exclusive jurisdiction of appropriate courts in Delhi / New Delhi only. All disputes shall be referred to the Sole Arbitrator appointed by the Management of Ltd. The decision of the arbitrator shall be final & binding. The arbitrator so appointed shall not be incapacitated for reasons of their being the employee of Ltd. or its sister concern, and for reasons of having any prior linkage with the company. The seat of arbitration will be Delhi. Ph: , , Fax: website: 4/6

5 Analyse Yourself 1. Which competitive exam(s) do you plan to take? IIT - JEE AIEEE CEE-DCE/NSIT NTSE STSE Olympiad SAT AIIMS CBSE PMT / PDT Other PMT Others (a) What does success mean to you? (b) What are your career goals? (c) What are your parents expectations? 3. (a) What have been your major academic & non-academic achievements till now? (b) What are your strengths & weakness? (c) How many times could you achieve as per your potential? Ph: , , Fax: website: itjee.com 5/6

6 4. (a) Why do you want to appear in IIT-JEE? (b) What according to you are your prospects in IIT-JEE? (i) Rate yourself on a scale of 1-10 (in terms of qualifying in JEE).... (ii) Rate yourself in terms of the rank that you think you can achieve (1-20, , , , , ).... (c) IITs & IT BHU have only 3550 seats for general category, if FIITJEE assesses that you should not prepare for IIT-JEE but focus on exams like AIEEE & CEE-DCE/NSIT, would you like to enroll for such a program? 5. (a) How do you plan to achieve your goals? (b) (i) What are the resources you require to achieve your goals? (ii) What are the skills you require to achieve your goals? (iii) What are the personality traits you require to achieve your goals? Ph: , , Fax: website: itjee.com 6/6