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National Admissions Ofce : FIITJEE House, 29 - A, Kalu Sarai, Sarvapriya Vihar, New Delhi - 110 016 Ph. : 011 - 46106000 / 10 / 13 / 15 All India Toll Free No. : 1800 11 4242 Fax : 011 - 26513942 Website : www.itjee.com
Enrollment Form
Please afx the 2nd passport size colour photograph of the student here
Please afx the 3rd passport size colour photograph of the student here
Please afx the stamp size colour photograph of the student here
Please submit 3 additional passport size colour photographs with this Enrollment Form
For Admission in Class 12th One Year Classroom Program for IIT-JEE - Regular Week Contact Classes One Year Classroom Program for IIT-JEE - Weekend Contact Classes One Year Classroom Program for IIT-JEE - Sunday Contact Classes One Year Classroom Program for IIT-JEE - Regular Week + Sunday Contact Classes One Year Classroom Program for AIEEE - Regular Week Contact Classes One Year Classroom Program for AIEEE - Weekend Contact Classes Special Weekend Classroom Program for IIT-JEE Intensive Contact Program for IIT-JEE Super Rank Enhancement Classroom Program for IIT-JEE Crash Course for AIEEE 1251 1252 1253 1254 1271 1272 1262 1281 1282 1286
For Admission After Class 12th One Year Extended Classroom Program for IIT-JEE - Regular Week Contact Classes One Year Classroom Program for IIT-JEE - Regular Week Contact Classes Special Classroom Program (for Ex-FIITJEEians) One Year Classroom Program for AIEEE - Regular Week Contact Classes Intensive Contact Program for IIT-JEE Super Rank Enhancement Classroom Program for IIT-JEE Crash Course for AIEEE 1351 1361 1362 1371 1381 1382 1386
Enrollment Form
Please Note :
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Check the availability of the program at your preferred FIITJEE centre before making a choice. Make a photocopy of this form after lling the required information and before submitting it to FIITJEE. Log on to www.itjee.com/regupdate.htm to update your Contact Details online using Registration Number and web access code printed on your Hall Ticket. Six identical passport size colour photographs of the student (One photograph should be pasted on this page, Two on the previous page and Three photographs should be submitted along with this Enrollment Form). One stamp size photograph (should be pasted on the previous page). Admission Test / FTRE / FTSE / Fortunate - 40 Hall Ticket (in Original). Admission offer letter (in Original). Any one of the following documents : n Photocopy of School ID card with photograph or n Photocopy of last Board or School Marksheet supported by any Identity Proof of student or n Photocopy of Transfer Certicate or n Bonade certicate issued by the Principal of School with students photograph
Test date
: _________________________________________________________ :___________________________________________
Please afx the 1st passport size colour photograph of the student here
Registration Number (as mentioned on the Hall ticket) Study centre Program Name / Code
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ _________________________________________________________________________________ Pin : _________________________________ Contact No (Mobile) Permanent Address (if any) : ____________________________ Land Line (with STD Code) : ___________________________________ : _______________________________________________________________________________________
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ _________________________________________________________________________________ Pin :_________________________________ Contact No. (Mobile) : ____________________________ Land Line (with STD Code) : ___________________________________
_________________________________________________________________________________ Pin : _________________________________ (a) Fathers Name Occupation : Business : _____________________________________ Qualication : ___________________________________ Govt. Service Pvt. Service Others (please specify) : __________________________
Name of the Company / Ofce Nature of Business / Job Department Ofce/Business Address
_________________________________________________________________________________ Pin : ________________________________ E-Mail ID (b) Mothers Name Occupation : Business : ________________________________________ Mobile No : __________________________________ : _____________________________________ Qualication : ___________________________________ Govt. Service Pvt. Service Others (please specify) : __________________________
Name of the Company / Ofce Nature of Business / Job Department Ofce/Business Address
Enrollment Form
(c) Details of the Local Guardian reference (Mandatory if the student is joining as a hosteller)
Local Guardians Name Occupation : Business : ________________________________________________ Qualication : ________________________ Govt. Service Pvt. Service Others (please specify) : __________________________
Name of the Company / Ofce Nature of Business / Job Department Ofce/Business Address
_________________________________________________________________________________ Pin :_________________________________ E-Mail ID Mailing Address : ________________________________________ Mobile No : __________________________________ : _______________________________________________________________________________________
(if applicable)
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Fee Details :
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: _______________________________________
Instrument Number
Dated
Amount
Enrollment Form
Detail(s) of Post Dated Cheques (Only Local / Payable at par cheques will be accepted) S. No.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Total
Instrument Number
Dated
Amount
Signature of Father / Mother / Legal Guardian Name : _________________________________ Date : __________________________________ Place : __________________________________
Enrollment Form
Declaration:
1. 2. I hereby declare that the information furnished on the enrollment form etc. is correct to the best of my knowledge and belief. I/we clearly understand that FIITJEE on completion of topics to be covered by FIITJEE in XI as per its plan will do goal refocusing for all Two Year Classroom Program students including PINNACLE program students to help each student achieve maximum possible success. This means that some students based on their performance, may have to predominantly focus on exams other than IIT-JEE. If any discrepancy in this information or otherwise is found at any stage of my association with FIITJEE, any action deemed t by FIITJEE including my expulsion from the institute may be taken against me. In such a case I or my parents/guardian shall have no claim for any type of compensation/refund of fees. I am taking admission in FIITJEE with the consent of my Father/Mother/Legal Guardian and after being satised in all respects. I understand that if I fail to complete/submit all remaining formalities/documents, if any, upto two days prior to the start of the classes, unless otherwise allowed in writing, I shall not be allowed to attend the classes till the needful is done, and in that case I or my father / mother / legal guardian shall have no claim for refund of fees or any compensation, including in studies. I understand that if I leave the institute before completing the full course for any reason whatsoever, including transfer of my father / mother / legal guardians / ill health of myself or any other member of the family or my admission in any institute / course / engineering college etc., or my studentship is cancelled because of misconduct etc. I or my father/mother/legal guardian shall have no claim for refund of fees. In addition to the above, I understand without any ambiguity that the fee once paid is not refundable at all, whatever the reasons be, nor is it adjustable towards any other existing courses at FIITJEE or any yet to be launched nor towards the fee of any other existing or prospective student. I will follow all rules & regulations of the associate school of FIITJEE Limited allotted to me in principle. And I agree that decision of FIITJEE management relating to all Terms & Conditions, Rules & Regulations of the associate school will be nal and binding in all circumstances and situations, whatsoever. It is understood that this admission is valid only for the course and the duration to which I am taking admission and I/We (the student and the parents) shall not claim/request for adjusting the fees to any other course or duration. I/We undertake that the course material whatever is given to the student during the course of study at FIITJEE, shall not be given to any one else for any purpose whatsoever.
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Enrollment Form
11. FIITJEE has enjoyed great relationship with students and parents. Almost all students in every class and every program have been succeeding in coping up with huge pressure of competitive exams along with school studies. In few cases where some students do discontinue because they are not able to cope up with competitive exam preparations along with school studies, the parents have continued to support the good work of FIITJEE. What will constitute deciency in service ? If the average feedback of the particular subject teacher goes below 70% in the Feedback Form Annexure - FB (attached herewith), then the said teacher will be considered to teach below the minimum FIITJEE Standard. If a teacher gets less than 70% feedback in two consecutive periods then his / her teaching will be considered unsatisfactory by high FIITJEE standards.. 12. I/We have fully satised ourselves with regards to quality and excellence of teaching at FIITJEE from all available information/sources and have decided to study only at FIITJEE. I/We wish to pay the entire fees as per the Fee Plan ____________ (Fee Plan I / Fee Plan II / Fee Plan III) option at our own sweet will and convenience without any pressure/coercion from any one. I/We agree to give a copy of the JEE Admit Card of the student by 25th March of the concerned JEE year to FIITJEE. I/We understand that (in case of scholarship student), if we fail to give the JEE admit card by 25th March of the concerned JEE year, FIITJEE will have the right to discontinue the scholarship and/or recover the scholarship with interest and the student / parents / legal guardian will have no objection for the same.
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15. I/We fully understand that FIITJEE is giving the scholarship because the student is expected to bring laurels to FIITJEE and will spread good word of mouth among the students. I/We will fully cooperate to achieve this objective including giving the JEE Admit Card before 25th March of the concerned JEE year and signing the letter of appreciation lauding FIITJEE efforts. 16. 17. I/We (student and the parents) declare that FIITJEE will have sole claim over the outstanding academic performance of the student and further agree to give a letter of appreciation to FIITJEE for the outstanding result. If a student is awarded scholarship by FIITJEE and does not perform at a similar level after joining FIITJEE Classroom / Integrated School Program then a probe may be lodged to nd out if the student got scholarship on his / her own merit or by using any unfair means. Parents and Guardians of the student will be liable to pay back full fee of the program (that the student is enrolled for) with interest plus expenses towards investigation and also a compensation of Rs. 10 Lacs, if the investigating committee concludes that student had not secured the scholarship on his / her own merits. Therefore, if your child has got scholarship using unethical means please do not take admission at FIITJEE. 18. 19. 20. I have read the above as well as the current FIITJEE Brochure carefully and have understood it clearly. I have also received a copy of this Enrolment Form, all other admission documents and FIITJEE Brochure for my future reference and timely compliance. I / We, the parent/guardian and/or the student, hereby severally and jointly declare unambiguously that I/we have read and understood all the clauses contained in the Declaration and agree to abide by them without any reservation or ambiguity. I / We further declare that the above named student is taking admission in the program as mentioned on page 3 having considered everything material, on his / her own sweet will after giving due consideration to rigors of time, distance and studies ahead and with the permission of the father/mother/legal guardian without any coercion from any side. Further I/We understand that the student is required to work hard to attain the average standard of the batch allotted in order to cope up with studies and put in extra efforts if lagging behind in any subject/topic. I / We further undertake to ensure that cheques/drafts including post dated cheques if any given by us will be honored by our bankers. In the event of these cheques/drafts being dishonored, FIITJEE is at liberty to initiate any action against us including legal proceedings to include invoking provisions of section 138 of Negotiable Instruments Act. I have read the above carefully and have understood it clearly. I have kept a photocopy of all the pages of this enrollment form including this declaration and Annexures A, B, C & D for my future reference and timely compliance. I know that registered ofce of FIITJEE Ltd. is situated at New Delhi. I promise to abide by all rules and regulations of FIITJEE declaration, in letter and spirit. In the event of any dispute regarding the interpretation of clauses of enrolment form or any claim etc. arising out of taking the admission in FIITJEE Ltd., the matter shall be referred to the Sole Arbitrator appointed by the Management of FIITJEE Ltd. The decision of the arbitrator shall be nal & binding on both parties. The arbitrator so appointed shall not be incapacitated for reasons of their being the employee or an associate of FIITJEE Ltd. or its sister concern, and for reasons of having any prior linkage with the company. The venue of Arbitration shall be Delhi / New Delhi only. Subject to clause 25 above, I/We (the student and the father/mother/legal guardian) understand that in case of any legal dispute, the jurisdiction will be an appropriate court/forum in Delhi/New Delhi only and I shall not take recourse to such an action in any other court/forum any where else. In case I do, I shall inform the relevant court/forum regarding this jurisdiction constraint.
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Signature of Father / Mother / Legal Guardian Name : _________________________________ Date : __________________________________ Place : __________________________________
Enrollment Form
(To be struck off, if not applicable) As my father / mother / legal guardian do(es) not reside in Delhi and I have no local guardian. I own all responsibility on their / his / her behalf.
(Declaration to be given if the Enrolment form is not signed by the Father/mother/legal guardian at the time of admission) I have received an extra copy of this Enrolment Form, which I shall send to my father/mother/legal guardian and submit to FIITJEE within 15 days with his/her signatures. If I fail to do so unless a further relaxation has been given by the FIITJEE authorities in writing, my admission shall be liable to be cancelled and I or my father/mother/legal guardian shall have no claim for refund of fees or any other compensation of any type.
Instruction : After lling-up annexure A, B, C, D please retain photocopy of the same before submitting at the FIITJEE Checklist : 1. Demand Draft(s) / Pay Order(s) for the fee. 3. Enrolment Form duly lled in. 5. Colour Photographs (a) Passport size (Six) (b) Stamp size 2.5 x 2 cm. (One) 2. Local / at par post dated cheque(s) 4. Annexure A to D
Enrollment Form
1. 2. 3. 4.
How would you rate the student in the following characteristics ? ( the appropriate)
Excellent Sincerity Leadership Imagination Emotional stability Ability to work with others Ability to work hard Perseverance Good Average Below Average Low Unknown
6. 7.
What is the students class rank? : ____________________________________________________________________________ Some gifted individuals make mediocre scholastic records. Is the students record an accurate index of his/her capabilities? Yes / No If no, state why? : ______________________________________________________________________________
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What is the students biggest weakness? : ______________________________________________________________________ Have there been any major changes in the students attitude towards studies till now at any time, if so illustrate, when and why?
(You may attach a blank page if required.)
10. Please mention any other information relating to the student, which help make FIITJEE understand the student better. ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ 11. My son / daughter / ward has a sound moral character & sense of responsibility. He/she also has good physical and mental health to successfully cope up & complete his/her studies at FIITJEE and fulll all terms & conditions.
Enrollment Form
Afx one self attested passport sized photograph of the person issuing Post Dated Cheque(s) i.e. parents / guardian
Cheque No.
Dated
Issuing Bank
Fee Amount
S. Tax Amount
Total Amount
I further agree, to get above Post Dated Cheque(s) cleared, even if, my son/daughter/ward discontinues studies at FIITJEE, irrespective of any reasons. I am signing the above declaration in good mental/physical health. I have satised myself about FIITJEE. The necessary Enrolment-Forms, including this form was received by me several days before the actual date of signing to enable me to understand the implications of taking admission at FIITJEE. I have taken expert opinion regarding matters which were not clear to me and I am satised.
Signature of the Student Name : ____________________________________________________ Enrolment Number (for ofce use only) : __________________________ Date : _____________________________________________________
Father / Mother / Legal Guardians Signature {Who has issued the cheque(s)} Name : ______________________________________ Address : ____________________________________
I have retained photocopy of this document for my reference before submitting it at FIITJEE. Date : _________________________________ Place : _________________________________
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Enrollment Form
Signature of the Student Name : ____________________________________________________ Enrolment Number (for ofce use only) : __________________________ Date : _____________________________________________________
Father / Mother / Legal Guardians Signature {Who has issued the cheque(s)} Name : ______________________________________ Address : ____________________________________
_____________________________________________ _____________________________________________
I have retained photocopy of this document for my reference before submitting it at FIITJEE.
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Enrollment Form
Annexure D
Kindly do not take admission at FIITJEE if the clauses of the declaration on the enrolment form along with the following amendment is not agreeable to you. Name of the Student : _________________________________________________________________________________________ Name of the Father / Parent / Guardian: ___________________________________________________________________________ Residential address : ___________________________________________________________________________________________ Specically Declaration 7 is being reproduced hereunder : Declaration 7 : In addition to the above, I understand without any ambiguity, that the fee once paid is not refundable at all, whatever the reasons be, neither is it adjustable towards any other existing courses at FIITJEE or any yet to be launched nor towards the fee of any other existing or prospective student. Declaration : I/We the Father/Mother/Legal Guardian and / or the student hereby severally and jointly declare that I / we have read and understood all the clauses contained in the Declaration on the Enrolment Form together with the above amendment and agree to abide by them without any reservation or ambiguity. I/We further declare that the above named student is taking admission in the ____________________________________________ ___________________________________________________(course opted for) having considered everything material and on his / her own sweet will and with the permission of the Father/Mother/Legal Guardian without any coercion from any side.
Signature of the Student Name : ____________________________________________________ Enrolment Number (for ofce use only) : __________________________ Date : _____________________________________________________
I have retained photocopy of this document for my reference before submitting it at FIITJEE.
Place : _____________________________
Name of the Accountant / Admission Coordinator. The Application form is complete in all respect with Annexure A,B,C and D duly signed by the student and the parent. The details of the scholarship offered. o Cash scholarship (If any) : _______________________________________________________________________________ o Fee Waivers offered (If any) : ___________ % on ____________________________________________________ ground. o Hostel fee waiver (If any) : ______________________________________________________________________________
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The certicates pertaining to scholarship are attached. 6 passport size and one stamp size photograph are attached. Late payment charges / Admin. charges duly calculated and collected. The fee charged has been duly matched and veried with the fee brochure. Signatures on PDCs and on Annexure B and C are same. Is the student joining as a Hosteller? If yes details of the Local guardian are provided. The student has been offered the admission after selection in Admission test only.
Declaration by the Accoutant / Admission Coordinator. I have veried the entire enrollment form and checked all the points mentioned above. The Enrollment is recommended.
Date : _______________________
Place : _________________________
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