REGISTRATION FORM

Registration No. :
(For official use only)

Test Date :

Please Affix Your Recent Passport Size Colour Photograph

Name of the Candidate Father's/Guardian's Name Date of Birth Name of the School Presently Attending School Address

: : :
D D M M Y Y Y Y

Nationality :

: : :

Pin Code School affiliated to Class studying in E-Mail ID of the Student

: : : : CBSE

Ph. No. : ICSE Others (Please Specify)

Medium of Instruction :

Aggregate Marks (%) Obtained in the last school exam / Board Examination: Present Res. / Local Guardian's Address :

Pin Ph. (Res.): E-Mail ID of Local Guardian Hostel Required

(only for boys)

Mobile No.: : : Yes No

FIITJEE Ltd. (FORUM FOR IIT-JEE), ICES House, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016
Ph: 011-2651 5949, 2656 9493, 2686 5182 Fax: 2651 3942 website: www.fiitjee.com

All India Toll Free No.: 1800 11 4242

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Permanent Residential Address :

Pin

Ph. (Res.):

Mobile No.:

Please fill in the following information :

FATHER Name (In Block Letters) Academic Qualifications Designation Name of Organization Office Address Telephone No. (Off.) Mobile No. E-Mail ID MOTHER

Which competitive exam(s) do you plan to take? IIT - JEE Olympiad State Level PMT AIEEE DCE / State Engineering Exams NTSE AIIMS STSE CBSE Medical

SAT (Scholastic Aptitude Test) Others

How did you come to know about the FIITJEE Classroom Programs? Fill in the appropriate choice(s). a) b) c) d) e) From present/ex-FIITJEEian From FIITJEE's brochure taken from From newspaper advertisement (please specify the newspaper) From posters / banners Other mode (Please specify) Name: Program:

Are you ready to be focused & get the best from FIITJEE Guidance.

FIITJEE Ltd. (FORUM FOR IIT-JEE), ICES House, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016
Ph: 011-2651 5949, 2656 9493, 2686 5182 Fax: 2651 3942 website: www.fiitjee.com

All India Toll Free No.: 1800 11 4242

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Please tick

program for which you want to register:

Two Year Integrated School Program

(for students of class XI)

IIT-JEE, 2008

Two Year Integrated School Program

(for students of class IX)

(Target IIT-JEE/Medical / Competitive Entrance Exams-2010)

ASCENT Plus Program prepares a student for Excellence in Boards, NTSE (National Talent Search Examination), Olympiads & a strong foundation for IIT-JEE / Medical Entrance.

IIT-JEE, 2008
(for students of class XI)
(Target IIT-JEE / Medical / Competitive Entrance Exams-2010)

(for students of class IX)

ASCENT Program prepares a student for Excellence in Boards, NTSE (National Talent Search Examination), Olympiads & a strong foundation for IIT-JEE / Medical Entrance.

ONE YEAR EXTENDED

CLASSROOM PROGRAM

SPECIAL WEEKEND CLASSROOM PROGRAM

IIT-JEE, 2007
(for XII pass students)

IIT-JEE, 2007
(for XII studying students)

IIT-JEE, 2007
(for XII pass students)

AIEEE ++, 2007

(for XII pass students)

For students of class XI (Aspirants of IIT-JEE, 2008) Mark Your Preference (1, 2 or X) PINNACLE Two Year Integrated School Program Two Year Classroom Program ( The Program that Produces Toppers) For students of class IX (Target IIT-JEE / Medical Entrance / Competitive Entrance Exams - 2010) Mark Your Preference (1, 2 or X) ASCENT Plus Two Year Integrated School Program ASCENT Two Year Classroom Program
Programs Available at Delhi (South Delhi- 26569493, North-West Delhi- 25222373 & East Delhi- 42448485), Delhi NCR (Ghaziabad - 951142448485, Gurgaon - 9511-26569493 & NOIDA - 9511-42448485), Amritsar (3203344), Bangalore (41135682), Bhilai (9329733322), Bhopal (4253355), Bokaro (325520), Chandigarh (3010044), Chennai (43057701), Hyderabad (66777000), Jaipur (5181885), Jammu (9906000707), Kolkata (30537576), Lucknow (2302533), Mumbai (9324966678), Patna (3299798), Ranchi (2563188) & Shakti Nagar NTPC (9450761633). For details contact your nearest FIITJEE centre or visit www.fiitjee.com.
Note 1 :All the centres are FIITJEEs own centres and not a franchise centre. Please see the attached list of FIITJEE Centres and Program Availability Grid for details. Note 2 : Generally all centres would offer all FIITJEE regular programs. FIITJEE school programs are available at some 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.

PREFERENCE OF TEST CENTRE

PREFERENCE OF STUDY CENTRE

FIITJEE Ltd. (FORUM FOR IIT-JEE), ICES House, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016
Ph: 011-2651 5949, 2656 9493, 2686 5182 Fax: 2651 3942 website: www.fiitjee.com

All India Toll Free No.: 1800 11 4242

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ADMISSION TEST DATES

Two Year Integrated School Program
for IIT-JEE, 2008 (for students of class XI)

PINNACLE

TWO YEAR CLASSROOM PROGRAM

for IIT-JEE, 2008
(for students of class XI)

Two Year Integrated School Program

Target IIT-JEE / Medical Entrance / Competitive Entrance Exams - 2010 (for students of class IX)

ASCENT Plus

ASCENT
Two Year Classroom Program
Target IIT-JEE / Medical Entrance / Competitive Entrance Exams - 2010 (for students of class IX)

ONE YEAR EXTENDED CLASSROOM PROGRAM

for IIT-JEE, 2007
(for XII pass students)

ONE YEAR CLASSROOM PROGRAM

for AIEEE ++, 2007
(for XII pass students)

Phase B

Test 1 - 11th June, 2006 Test 2 - 2nd July, 2006

Phase C Phase D

Test - 25th June, 2006

Phase C Phase D Phase E Phase F

Test

- 11th June, 2006

Phase A

Test 1 - 23rd July, 2006 Test 2 - 6th Aug., 2006

1 - 25th June, 2006 { Test Test 2 - 2nd July, 2006 Test Test - 16th July, 2006 - 30th July, 2006
Phase B

1 - 11th June, 2006 { Test Test 2 - 18th June, 2006

SPECIAL WEEKEND CLASSROOM PROGRAM

for IIT-JEE, 2007
(for XII studying students)

ONE YEAR CLASSROOM PROGRAM

for IIT-JEE, 2007
(for XII pass students)

Test 1 - 9th July, 2006 Test 2 - 16th July, 2006 Test 3 - 30th July, 2006

Test - 9th July, 2006

Test 1 - 20th August, 2006 Test 2 - 27th August, 2006

Admission Test Centres

1. All FIITJEE Centres : Registration Open. 2. Guwahati(TollFreeNo.1800114242) &Vizag(9885458155) : RegistrationOpen. 3. Admission Tests on 11th June, 25th June, 2nd July & 16th July, 2006 will also be conducted at the following centres viz. Bhubaneshwar (9338468463), Gorakhpur (9336079589), Hisar (011-25222373), Jamshedpur (9835311710), Kanpur (9336079589), Karnal (011-25222373), Kharagpur (9339557576), Rohtak (011-25222373), Varanasi (9336079589), Vijayawada (9885323397), Agra, Ajmer, Allahabad, Bhagalpur, Dehradun, Dhanbad, Durgapur, Gwalior, Indore, Jabalpur, Jhansi, Jodhpur, Kota, Meerut, Muzaffarpur, Nagpur, Pune, Raibareilly, Rourkela, Thiruvananthapuram & Udaipur (Toll Free No.: 1800 11 4242 foralltheabovecities). OnthespotregistrationwillcommencefivedaysbeforethetestdateattheaboveAdmissionTestvenues.

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 photographs and Rs. 400/- (Rupees Four Hundred only, inclusive of service tax), {for ASCENT & ASCENT Plus programs the test fee payable is Rs. 200/- (Rupees Two Hundred only, inclusive of service tax)} by Demand Draft (for D/D payment details visit www.fiitjee.com/feepayment.htm).
In case of Two Year Classroom Program or ASCENT Two Year Classroom Program if your first choice is Weekend or Sunday Contact Program, you are required to deposit Rs. 500/- (Rupees Five Hundred 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 www.fiitjee.com/feepayment.htm).

The registration fee & batch option fee can also be paid in cash in person at FIITJEE office.

Last Date to Register

In person : One day before the Test Date. By post : Seven days before the Test Date
Dated Bank

Fee Paid Rs.

in Cash / DD / Pay Order No.:

Date: Place:
Note 1: Note 2: Note 3: Note 4: Note 5: Note 6:

(Signature of Student)
FIITJEE reserves the right to offer any study centre, other than the one opted by the student, subject to availability / constraints of seats. 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. FIITJEE reserves the right to change / cancel any program, test date, eligibility criterion & course fee without prior notice. The registered office of FIITJEE 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 FIITJEE 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 FIITJEE Ltd. or its sister concern, and for reasons of having any prior linkage with the company.

FIITJEE Ltd. (FORUM FOR IIT-JEE), ICES House, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016
Ph: 011-2651 5949, 2656 9493, 2686 5182 Fax: 2651 3942 website: www.fiitjee.com

All India Toll Free No.: 1800 11 4242

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