Father’s Full Name: __________________________ Occupation: ___________________ Mother’s Full Name: _________________________ Occupation: ___________________ Father’s Mobile: ___________ Mother’s Mobile: ___________ Email (Parent): ________________ Annual Family Income (approx.): Below 2L / 2L-5L / 5L-10L / Above 10L Local Guardian (if student stays away): Name: _______________ Contact: _______________
School/College Name currently attending: ________________________________________________ Medium of Instruction: English / Hindi / Other: ___________ Have you ever failed in any exam? Yes / No (If yes, details): _________________________
Parent/Guardian Name: ___________________ Signature: _______________ Date: __________
SECTION H: OFFICE USE ONLY
I, the parent/guardian of the above-named student, certify that all information provided is true and correct to the best of my knowledge. I agree to abide by the rules, regulations, fee structure, and attendance policy of the coaching institute. I understand that the admission may be cancelled if any information is found false.
Residential Address: ___________________________________________________________________ City: _______________ PIN: _______________ State: _______________ Landmark: __________________________________ Residence Type: Own / Rent / PG / Hostel
SECTION A: STUDENT PERSONAL DETAILS
Course applying for (tick one): [ ] IIT-JEE (Main+Advanced) [ ] NEET (UG) [ ] FOUNDATION (8th-10th) [ ] BOARD (11th-12th) [ ] COMMERCE (CA/CS/CMA) [ ] CLAT / LAW [ ] OTHER: ___________________
I confirm that I have understood the course structure, timings, and code of conduct. I will attend classes regularly, submit assignments on time, and maintain discipline.
Checklist (Tick & attach photocopies – originals for verification): [ ] Class X Marksheet [ ] Class XII Marksheet (if applicable) [ ] Transfer/Leaving Certificate [ ] Aadhaar Card (student) [ ] Passport size photos (4 copies) [ ] Caste certificate (if applicable) [ ] Parent’s ID proof [ ] Medical certificate (if any disability) coaching classes admission form word format
Full Name (as per school records): ______________________________________________________ Date of Birth: ___________ Age: ___________ Gender: M / F / Other Blood Group: _______ Aadhaar Number (optional): _________________ Nationality: _______________ Category: General / SC / ST / OBC / Other (specify): ___________ Physically Challenged: Yes / No (If yes, specify disability): _________________ Email ID: __________________________________ Mobile No.: ___________________ Alternate Contact No.: ______________________ WhatsApp No.: ________________
Target exam year: ___________ Preferred mode: Classroom / Online / Hybrid Preferred batch timing: Morning / Afternoon / Evening / Weekend Have you taken coaching before? Yes / No If yes, name of institute & duration: _______________ Reason for joining us: ______________________________________________________________
SECTION B: RESIDENTIAL & PARENT/GUARDIAN DETAILS I understand that the admission may be cancelled
SECTION D: COACHING & COURSE DETAILS
SECTION F: DECLARATION BY PARENT/GUARDIAN