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1. Name    
2. Class:      
4. Address      
     Phone No.     (M)
5. Father's Name:     Occupation:
6. Email:      
7.School/Collages:      
       
COURSE TO BE JOINED (TICK THE APPROPRIATE COLUMN)
1. TYRP : Two Year Regular Program (Student Studying in XI Class)
2. OYRP : One Year Regular Program (Student Studying in XII Class)
3. ORCP : One Year Classroom Program (For XII Pass Student)
4. ICP : Intensive Classroom Program (For IIT)
 5. CRASH COURSE 6. FINISHING TOUCH 7. Test-SERIES IIT/DCE/AIEEE
  ACADEMIC DETAILS  (Attach a photocopy of all relevant marksheets)
CLASS NAME OF THE SCHOOL BOARD MARKS OBT./MAX. MARKS % AGE
X    
MATHS /
SCIENCE /
XI    
PCM /
XII    
PCM /
Place : Date :
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