Download - Enrollment Form Fiitjee

E n r o l m e n t F o r m

Enrolment Number (for official use only)

( f o r C l a s s r o o m / I n t e g r a t e d S c h o o l P r o g r a m s )

Please Note :

v Check the availability of the program at your preferred FIITJEE centre before making a choice.

v MakeaphotocopyofthisformafterfillingtherequiredinformationandbeforesubmittingittoFIITJEE.

v Logontowww.fiitjee.com/regupdate.htmtoupdateyourContactDetailsonlineusingRegistrationNumberandwebaccesscodeprintedon

your Hall Ticket.

Items required to be submitted along with this form :

v Six identical passport size colour photographs of the student (One photograph should be pasted on this page, Two on page no. 13 and

Three photographs should be submitted along with this Enrolment Form).

v One stamp size photograph (should be pasted on page no. 13).

v AdmissionTest/FTRE/FTSE/Fortunate-40HallTicket(inOriginal).

v Admission offer letter (in Original).

v Any one of the following documents :

n PhotocopyofSchoolIDcardwithphotographor

n Photocopy of last Board or School Marksheet supported by any Identity Proof of student or

n PhotocopyofTransferCertificateor

n BonafidecertificateissuedbythePrincipalofSchoolwithstudent’sphotograph

Original should be presented for verification at the time of admission.

Instruction for filling Enrolment Form

Pleasereadcarefullythe“ImportantInformationforStudents(&theirParents/LegalGuardians)”and“Declarations/Undertakings”sectionon

pageno.9,10&11respectivelybeforefillingthisForm.

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Enrolment Form

Registration Number (as mentioned on the Hall Ticket) :_______________________________________________

Study Centre : _________________________________________________________

Program Name (refer page no. 13 & 14) : ________________________________________________________________________

Program Code (refer page no. 13 & 14) : ________________________________________________________________________

Scholarship Awarded % (if applicable) : ________________________________________________________________________

Student’s Name (in Block Letters) : _______________________________________________________________________________________

Date of Birth : ________/_______/___________ E-mail ID :_________________________________________________

Mailing Address : _______________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

_________________________________________________________________________________ Pin : _________________________________

Contact No (Mobile) : ____________________________ Land Line (with STD Code) : ___________________________________

Permanent Address (if any) : _______________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

_________________________________________________________________________________ Pin :_________________________________

Contact No. (Mobile) : ____________________________ Land Line (with STD Code) : ___________________________________

School/College Last Attended / Presently Attending : _____________________________________________________________________

Address : _______________________________________________________________________________________

_________________________________________________________________________________ Pin : _________________________________

(a) Father‘s Name : ________________________________________________ Qualification : _________________________

Occupation : Business � Govt. Service � Pvt. Service � Others (please specify) : __________________________

Name of the Company / Office : _______________________________________________________________________________________

Nature of Business / Job : ____________________________ Designation : _____________________________________________

Department : ____________________________ Contact No (office) : _________________________________________

Office / Business Address : _______________________________________________________________________________________

_________________________________________________________________________________ Pin : _________________________________

E-Mail ID : ________________________________________________ Mobile No : ___________________________

(b) Mother‘s Name : ________________________________________________ Qualification : _________________________






_________________________________________________________________________________ Pin : _________________________________


Please affix the 1st passport size colour

photograph of the student here

Test date :______/______/_____________

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Enrolment Form

(c) Details of the Local Guardian reference (Mandatory if the student is joining as a hosteler)

Local Guardian’s Name : ________________________________________________ Qualification : ________________________






_________________________________________________________________________________ Pin : _________________________________


Mailing Address : _______________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

_________________________________________________________________________________ Pin: _________________________________

(d) Details of the Sibling(s) (if applicable)

1. Name : _______________________________________________________________________________________

Class studying in : ___________________________ Enrolment No. (if enrolled with FIITJEE) :_________________________

2. Name : _______________________________________________________________________________________


3. Name : _______________________________________________________________________________________


Name of the Examination(s) Board Year of passing / appearedTotal

Aggregate Marks (%)

PCM / Science + Math

(%)

Details of the examination(s) of the class last passed / currently studying

Detail(s) of Demand Draft(s) / Pay Order(s)

S. No. Instrument Number Dated Issuing Bank & Branch Amount (in Rs.)

1

2

3

4

Total

Fee Details : Fee Plan opted (√): I □ II □ III □

Fee Plan Code : _______________________________________ (please refer course fee Annexure)

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Enrolment Form

Annexure “A”

TERMS & CONDITIONS FOR POST DATED CHEQUE(S)

Iunderstandthatifmyson/daughter/wardwithdrawsfromtheProgramtowhichhe/shehasbeenadmittedatanypointoftimeordoesnotattendtheProgramandthustheseatgiventohim/herisrenderedvacant,thesamewillnot/cannotbefilledupbyanyothercandidateandavacancycreatedinthebatchduetowithdrawalofastudentafterthestartingofclassesorupto2dayspriortothesamecannotbefilledinanycase,thereforeIunderstandthatFIITJEEshallsufferirreparablelossesincaseofnon-paymentofremainingfeeoftheinstallmentplan,henceitwillbeunethicalnottohonorthePostDatedCheque(s).IhaveoptedforinstallmentfeeplanandhavesubmittedthePostDatedCheque(s)asperthedetailsgivebelow.

Iagreethat,Iwillmakearrangement,forbelowstatedPostDatedCheque(s),togethonored,andwillkeepsufficientfundsonorbeforetheduedateforthesame.

I further agree to get above PostDatedCheque(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 satisfied myself about FIITJEE. The necessary Enrolment-Forms,includingthisformwasreceivedbymeseveraldaysbeforetheactualdateofsigningtoenablemetounderstandtheimplicationsoftakingadmissionatFIITJEE.IhavetakenexpertopinionregardingmatterswhichwerenotcleartomeandIamsatisfied.

SignatureoftheStudent Father/Mother/LegalGuardian’sSignature

Name : ____________________________________________________ {Whohasissuedthecheque(s)}

EnrolmentNumber(for office use only) : __________________________ Name : ______________________________________

Date : _____________________________________________________ Address : ____________________________________

I have retained photocopy of this document for my reference before submitting it at FIITJEE.

Date : _________________________________ Father/Mother/LegalGuardian’sSignature

Place : _________________________________ Name : ______________________________________

Detail(s) of Post Dated Cheques (Only Local / Payable at par cheques will be accepted)

S. No. Cheque No. Dated Issuing Bank Fee Amount S. Tax Amount Total Amount

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

Affix one self attested passport sized

photograph of the person issuing Post Dated

Cheque(s) i.e. parents / guardian

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Enrolment Form

Annexure “B”

CONSEQUENCES OF DISHONOUR OF POST DATED CHEQUE(s)

Iunderstandthatnon-clearanceofanyofthePostDatedCheque(s),submittedforpaymentoffees(oninstallmentbasis)asmentioned

intheEnrolment-Formandannexure“B”ispunishableunderSec.138(B)oftheNegotiableInstrumentAct.IunderstandthatFIITJEE

shallbeentitledtoproceedandinitiateappropriatelegalactionagainstme,torecovertheamountofthePostDatedCheque(s)along

with the legal expenses and out of pocket expenses incurred by FIITJEE.

IncaseanyofmyPostDatedCheque(s)bounces foranyreasonwhatsoever, Iundertake tosubmitaDD/Pay-Order in favourof

“FIITJEELtd.”payableatNewDelhi,withinfourdaysofthebouncingoftheCheque(s)atmybank,togetherwithRs.500/-(Rupees

fivehundredonly)asdefaultmoneyalongwithlatepaymentofRs.50/-(Rupeesfiftyonly)perdayupto10(Ten)daysfromthedue

dateofpaymentofinstalmentafterwhichmyson/daughter/wardshallbedebarredfromclasseswithoutanyfurthernoticeandIshall

havenoclaimforrefundoffeesoranysupportinstudiesbesidesLegalactioninteraliaactionunderSection138(B)oftheNegotiable

InstrumentActmaybeinitiatedagainstme/us.


Name : ____________________________________________________ {Whohasissuedthecheque(s)}

EnrolmentNumber(for office use only) : __________________________ Name : ______________________________________

Date : _____________________________________________________ Address : ____________________________________

_____________________________________________

_____________________________________________


Date : _________________________________ Father/Mother/LegalGuardian’sSignature

Place : _________________________________ Name : ______________________________________

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Enrolment Form

Excellent Good Average Below Average Low Unknown

Sincerity

Leadership

Imagination

Emotional stability

Ability to work with others

Ability to work hard

Perseverance

Annexure “C”

PARENT DATA SHEET

(CONFIDENTIAL)

DearParent/Guardian,

Therightandaccuratefeedbackofyourward/studentwillgiveusanopportunitytounderstandthestudentbetterwhichwillhelpus

inprovidingbettersupport&education.Thisinformationwillbeconfidential.

1. NameoftheStudent : ______________________________________________________________________________

2. Father’s/Guardian’sName : ______________________________________________________________________________

3. RelationwithStudent : ______________________________________________________________________________

4. Howwouldyouratethestudentinthefollowingcharacteristics?(√theappropriate)

6. Whatisthestudent’sclassrank? : ____________________________________________________________________________

7. Somegiftedindividualsmakemediocrescholasticrecords.Isthestudent’srecordanaccurateindexofhis/hercapabilities?

Yes/No

Ifno,statewhy? : ______________________________________________________________________________

8. Whatisthestudent’sbiggestweakness?: ______________________________________________________________________

9. Havetherebeenanymajorchangesinthestudent’sattitudetowardsstudiestillnowatanytime,ifsoillustrate,whenandwhy?

(You may attach a blank page if required.)

10. Pleasementionanyotherinformationrelatingtothestudent,whichhelpmakeFIITJEEunderstandthestudentbetter.

________________________________________________________________________________________________________

________________________________________________________________________________________________________

11. Myson/daughter/wardhasasoundmoralcharacter&senseofresponsibility.He/shealsohasgoodphysicalandmentalhealth

tosuccessfullycopeup&completehis/herstudiesatFIITJEEandfulfillallterms&conditions.

Father/Mother/LegalGuardian’sSignature

Date : _________________________________

Place : _________________________________

8

Enrolment Form

Annexure “D”

Kindly do not take admission at FIITJEE if the clauses of the declaration on the Enrolment Form on page no. 10 & 11

is not agreeable to you.

NameoftheStudent : _________________________________________________________________________________________

NameoftheFather/Parent/Guardian: ___________________________________________________________________________

Residentialaddress : ___________________________________________________________________________________________

Specifically Declarations (10 & 22) is being reproduced hereunder :

Declaration 10 :

In addition to the above, I understand without any ambiguity, that the fee once paid is not refundable at all, whatever the reasons be,

neitherisitadjustabletowardsanyotherexistingcoursesatFIITJEEoranyyettobelaunchednortowardsthefeeofanyotherexisting

or prospective student.

Declaration 22 :

I/We,theparent/guardianand/orthestudent,herebyseverallyandjointlydeclareunambiguouslythatI/Wehavereadandunderstood

alltheclausescontainedinthisEnrolmentform,AnnexureandDeclarationsandagreetoabidebythemwithoutanyreservationor

ambiguity.

I/Wefurtherdeclarethattheabovenamedstudentistakingadmissioninthe ____________________________________________

___________________________________________________(courseoptedfor)havingconsideredeverythingmaterialandonhis/her

ownsweetwillandwiththepermissionoftheFather/Mother/LegalGuardianwithoutanycoercionfromanyside.


Name : ____________________________________________________ Name : ________________________________________

EnrolmentNumber(for office use only) : __________________________ Address : _______________________________________

Date : _____________________________________________________ ________________________________________________


Date : _______________________________ Place : _____________________________ Father/Mother/LegalGuardian’sSignature

Instruction : Afterfilling-upannexure“A”,“B”,“C”&“D”pleaseretainphotocopyofthesamebeforesubmittingattheFIITJEE

Checklist : 1.DemandDraft(s)/PayOrder(s)forthefee �

2.Local/atparpostdatedcheque(s) �

3.EnrolmentFormdulyfilledin �

4.Annexure“A”to“D” �

5. Colour Photographs:

(a) Passport size (Six) �

(b) Stamp size 2.5 x 2 cm. (One) �

6.AdmissionTest/FTRE/FTSE/Fortunate-40HallTicket(inOriginal) �

7. Admission offer letter (in Original) �

8. Any one of the following documents :

(a)PhotocopyofSchoolIDcardwithphotographor �

(b) Photocopy of last Board or School Marksheet supported by any Identity Proof of student or �

(c)PhotocopyofTransferCertificateor �

(d)BonafidecertificateissuedbythePrincipalofSchoolwithstudent’sphotograph �

9

Enrolment Form

IMPORTANT INFORMATION FOR STUDENTS (and their parents / legal guardians)

1. BeforeTakingAdmission-EachCandidate,His/HerParents&LegalGuardiansarerequiredto-

(a) GothroughtheFIITJEELeaflet/Brochure/InformationBooklet,wordofadvice,selectionletter&websitethoroughly.Otherthantheseno

other verbal assurance of any kind is given by FIITJEE.

(b) ItisadvisedthatstudentundergoesacomprehensiveMedicalExaminationtoensurethathe/sheisphysically&mentallyfittotaketherigors

of preparing for a competitive exam including but not limited to JEE (Advanced) & JEE (Main) etc. as the case may be.

(c) MeetfewFIITJEEstudentssuccessfulinIIT-JEE/AIEEE{nowJEE(Advanced)&JEE(Main)respectively},NTSEetc&learnwhatmadethem

successful.WhatwasthecontributionofFIITJEEintheirsuccess?AlsomeetafewFIITJEEstudentsnotsuccessfulinIIT-JEE/AIEEE{now

JEE(Advanced)&JEE(Main)respectively}/NTSE&learnwhytheycouldnotqualifyIIT-JEE/AIEEE{nowJEE(Advanced)&JEE(Main)

respectively}/NTSE.

WehighlyadvisethatyoualsotalktoNon-FIITJEEstudentsbothsuccessfulinIIT&theunsuccessfulones,toformaclearopinionregarding

what a coaching institute can do for you.

Please do not take admission at FIITJEE if you think FIITJEE is not the best for JEE coaching.

Anintelligentstudenthavingaptitude&analyticalskillsforJEE/NTSEetchastohaveselfstudyforatleast3hrs.foreveryhourtaughtat

FIITJEE.Needlesstosayifyouhavenotbeenahighlyanalyticalstudentyouhavetoputinevengreaterefforts.

For success in JEE, it is also important to have excellent performance In XII Board Exams. Furthermore, JEE is a different exam where you

willfeellostifyoudonotfocusonfundamentalsand/oryoudonotdevelop/havehighanalyticalskills.Anyamountofeffortwillbeinvain

without high analytical skills. Admission at FIITJEE does not mean that you have high analytical skills. FIITJEE teachers will guide you in such a

way that your fundamentals are strengthened and you can improve your analytical skills tremendously, whether it happens or not will depend

uponyou.Theonlywaytodevelopstrongfundamentals&improveyouranalyticalskills&thereforeyourchancestogetthroughJEE(Main)/

JEE(Advanced)/NTSE,etcwithexcellentSchool/Boardperformanceistosolveeach&everyprobleminFIITJEEassignmentsyourself.You

mayhavetomakeseveralattempts&evengobacktoyourbasicstorefreshthemtosolveaparticularproblem.Itisthisintensity&quality

ofeffortwhichwillhelpyoudevelopgoodanalyticalskills.Ultimatelyabovestudentwhoisenrolledwithinstitutewillhavetocontinuously

work hard and must be regular in studies. In case, the teachers feel that the student is not working hard, is creating indiscipline in the Institute,

is irregular inattendanceor isnotrespondingproperly,he/shemaybeexpelledfromtheinstitute.ThedecisionofFIITJEEinthisregard

will/shallbefinalandbindingonthestudents.Nofeeorpartofthefeewillberefundedinsuchcase.

Intheend,rememberwhileanyonecanappearinJEE(Main)/JEE(Advanced)orpretendtopreparebutonlytheoneswhowalktherightpath

succeed. FIITJEE has no magic potion to make you successful. Preparing to achieve optimum performance in both Boards & JEE will challenge

every bit of your mental & physical energies.

2. FIITJEEstartsmakingarrangementsof infrastructure, faculty&other resourcesabout6monthsbeforecommencementoffinancial year.

FIITJEEadmitsstudentsasperitscapacityplans,(subjecttounforeseencircumstances&usualorganizationalrisks)thereforeeachstudent

takingadmissionhas topaycomplete feeunderall circumstances i.e.even ifhe/shediscontinues foranyreasonwhatsoeverorparents /

guardiansbetransferred.Notallstudentswhositinouradmissiontestareofferedadmissionthereforeyou&parentshavetobeverysure

before taking admission as you have to pay complete fee under all circumstances.

OnceaclassstartsFIITJEEdoesnotadmitanystudents.Therefore,anyvacancycreatedbyastudentleavingcannotbefilledup.SinceFIITJEE

has to source infrastructure, faculty etc. in advance, loss of fees of students leaving after taking admission will compel the institute to enhance

feesfornextbatchofstudentswhichisunfairtothem.Therefore,students/parentsmustclearlyunderstandthisimportantaspectandtake

admissiononlyiftheyarefullysatisfied.

3. Anychange ingovernmentrules,regulations,policiespertainingtothecoursesofcompetitiveexamsuchas JEE(Main) / JEE(Advanced),

Olympiads,KVPY,NTSEetc.whichmayrendertheseexamsasdeletedorcancelledinsucheventuality,FIITJEEshallnotbeheldresponsible

in any manner whatsoever. However, FIITJEE shall take all necessary steps to protect the interest of students.

Student’s Signature Signature of Father / Mother / Legal Guardian

Name : _________________________________ Name : _________________________________

Date : __________________________________ Date : __________________________________

Place : __________________________________ Place : __________________________________

10

Enrolment Form

Kindly do not take admission at FIITJEE, if the following declarations are not agreeable to you

Please read the Declarations / Undertakings carefully before signing

Declaration:

1. I/Weherebydeclarethattheinformationfurnishedonthisenrolmentformetc.iscorrecttothebestofmyknowledgeandbelief.

2. IamtakingadmissioninFIITJEEwiththeconsentofmyFather/Mother/LegalGuardianandafterbeingsatisfiedinallrespects.

3. I/Weundertakethattheinformation/detailsfurnished/givenbyme/usarecorrectandifanydiscrepancyisfoundinthesaiddetails/information,atanystageofmyassociationwithFIITJEE,FIITJEEmaytakeanylegalactionagainstme/uswhichFIITJEEmaydeemfitincludingbutnotlimitedtomy(student)expulsionfromtheinstituteandI/Weshallnotbeentitledforanyrefundoffees/claim/compensation/damagesetc.

4. I/Weundertakethat I/Weshall furnish / submit /complete theremainingrequireddocumentsand formalitiesbyat least twodaysprior tocommencement of course program. However if I fail to do so, FIITJEE may not allow me to attend the classes, unless otherwise allowed by theFIITJEEinwriting.I/WefurtherundertakethatI/Weshallnotclaimanyrefundoffees/costofstudymaterialetc.alreadypaidongroundofinabilitytofurnish/completedocuments/formalities.

5. I/WeunderstandandacknowledgethatFIITJEEdoesnotgiveanyguarantee/promise/assuranceforsuccessinJEE(Main)/JEE(Advanced)/XIIboards,inspiteofprovidingthebestteachingfacultyandmethodology,duetohigh-endcompetitionandlimitednumberofseatsinIIT. I undertake that I shall not hold FIITJEE responsible if I may not crack the JEE or other competitive exam.

6. I/Weunderstandandacknowledgethatpreparationfor JEErequiresexhaustivehardwork,extensivestudy,motivationandselfconfidence. IundertakethatIshallfollowtherulesandteachingmethodologybesidestudyandpracticerigorouslywithoutloosingself-confidence.

7. I/WeclearlyunderstandthatFIITJEEoncompletionoftopicstobecoveredbyFIITJEEinClassXIasperit’splan,willdogoalrefocusingforallTwoYearClassroomProgramstudentsincludingPINNACLEprogramstudentstohelpeachstudentachievemaximumpossiblesuccess.Thismeans that some students based on their performance, may have to predominantly focus on exams other than JEE (Main & Advanced).

8. I undertake that if I leave the institute midway before completing the full course for any reason whatsoever, including but not limited to transfer ofmyFather/Mother/LegalGuardian/ illhealthofmyselforanyothermemberofthefamilyormyadmission inany institute/course/engineeringcollegeetc.,ormystudentshipiscancelledbecauseofmisconductetc.,IormyFather/Mother/LegalGuardianshallnotbeentitledfor refund of fees.

9. I/WeundertakethatonceI(student)jointhestudycentre/programofferedbyFIITJEE,I/Weshallnotbeentitledtochangethestudycentre/programnorwillIbeentitledtorefundoffees.However,ifFIITJEEfindsmecompetent/eligibleforthehighercourse/program,itmayconsidermyrequestforchangeofprogramsubjecttopaymentofdifferenceofcourse/programfee.

10. Inadditiontotheabove,Iunderstandwithoutanyambiguitythatthefeeoncepaidisnotrefundableatall,whateverthereasonsbe,norisitadjustabletowards any other existing courses at FIITJEE or any yet to be launched nor towards the fee of any other existing or prospective student.

11. IundertakethatIshallabidebytherules&regulationsofFIITJEEorFIITJEE’sassociatedschools.Iundertakethatincaseofanydisputerelatingtobreach/violationofanyoftheRules&RegulationsofFIITJEEorFIITJEE’sassociatedschool,thedecisionoftheManagementofFIITJEEshallbefinalandbindinginallcircumstancesandsituations,whatsoever.

12. ItisunderstoodthatthisadmissionisvalidonlyforthecourseandthedurationforwhichIamtakingadmissionandI/We(thestudentandtheParents/LegalGuardian)shallnotclaim/requestforadmissiontoandadjustingthefeestoanyothercourseorduration.

13. I/WeacknowledgethatthecoursematerialsprovidedtothestudentbyFIITJEEduringthecourseofstudyatFIITJEEaretheintellectualpropertyof FIITJEE and solely for personal purposes and not for commercial use. I further undertake that I shall not make copies of the study material providedbytheFIITJEEnorshallprovide/give/distributeittoanyoneelse.

14. FIITJEEhasenjoyedgreatrelationshipwiththestudentsandparents.Almostallstudentsineveryclassandeveryprogramhavebeensucceedingincopingupwithhugepressureofsimultaneouspreparationforcompetitiveexamsalongwithschool/boardstudies.Infewcaseswheresomestudentsdodiscontinuebecause theyarenotable tocopeupwithsimultaneouscompetitiveexampreparationsalongwithschool /boardstudies, the parents have continued to support the good work of FIITJEE.

Whatwillconstitutedeficiencyinservice?

Iftheaveragefeedbackoftheparticularsubjectteachergoesbelow70%intheFeedbackForm“Annexure-FB”(attachedherewith),thenthesaidteacherwillbeconsideredtoteachbelowtheminimumFIITJEEStandard.Ifateachergetslessthan70%feedbackintwoconsecutiveperiodsthenhis/herteachingwillbeconsideredunsatisfactorybyhighFIITJEEstandards.

15. I/WehavefullysatisfiedourselveswithregardstoqualityandexcellenceofteachingatFIITJEEfromallavailableinformation/sourcesandhavedecidedtostudyonlyatFIITJEE.I/WewishtopaytheentirefeesaspertheFeePlan____________(FeePlanI/FeePlanII/FeePlanIII)option(the same is signed by me & the student and is attached with this enrolment form) at our own sweet will and convenience without any pressure /coercionfromanyone.

16. I/WeagreetosubmitaphotocopyoftheJEEAdmitCardofthestudentby25thMarchoftheconcernedJEEyeartoFIITJEEandadmitcardofvariousOtherEngineeringEntranceExamassoonasI/Wereceivethesamefromtheexaminingbody.


Name : _________________________________ Name : _________________________________

Date : __________________________________ Date : __________________________________

Place : __________________________________ Place : __________________________________

DECLARATIONS / UNDERTAKINGS

11

Enrolment Form

17. I/WefullyunderstandthatFIITJEEisgivingthescholarshipbecausethestudentisexpectedtobringlaurelstoFIITJEEandwillspreadgoodwordofmouthamongthestudents. I/WeundertakethatI /weshall /will fullycooperatetoachievethisobjectiveincludinggivingtheJEEAdmitCardbefore25thMarchoftheconcernedJEEyearandsigningtheletterofappreciationlaudingFIITJEEefforts.I/Wefurtherundertakethat I/Weshallattendtheseminars/workshops/felicitation/interviewetc.conductedbyFIITJEEafterachievingrankbythestudent;howevertheFIITJEE shall alone bear the entire cost and expenses in respect thereof. I further undertake to endorse the efforts and contributions made by FIITJEEInachievingtherankwhilegivingInterviewstothemedia(print/electronic/web).IfwefailtogivetheJEEadmitcardby25thMarchoftheconcernedJEEyear,FIITJEEwillhavetherighttodiscontinuethescholarshipand/orrecoverthescholarshipwithinterestandthestudent/parents/legalguardianwillhavenoobjectionforthesame.

18. I/We(studentandtheparents)declarethatFIITJEEwillhavesoleclaimovertheoutstandingacademicperformanceofthestudentandfurtheragreetogivealetterofappreciationtoFIITJEEfortheoutstandingresultinformofaLetter,aVideoIntervieworanyotherforum/formatthatFIITJEEdeemsfit.

19. I/WeundertakeandacknowledgethatincaseI/WeindulgeinanykindoflitigationwiththeFIITJEE,I/WeshallnotbeentitledforanyAwards/Rewards/Scholarships/Benefitsetc.fromFIITJEEandshallrefund/returnsuchAwards/Rewards/Scholarships/Benefitsetc.Ifavailedbythestudent,withinaperiodof15days,failingwhichFIITJEEshallbeentitledtorecoverthesamefromtheappropriatecourt/forumalongwithinterest, damages and cost of litigation.

20. I/WeundertakethatI(student)shallnotindulgeinanyillegal/unethical/unprincipled/immoral/corrupt/dishonestactivitieswhichmaycause lossofproperty,reputationandgoodwillofFIITJEE. I/Wefurtherundertakethat I/Weshallcompensatefor/ indemnifyagainstany loss/damagecausedtoFIITJEE.

21. IfastudentisawardedscholarshipbyFIITJEEanddoesnotperformatasimilarlevelafterjoiningFIITJEEClassroom/IntegratedSchoolProgramthenaprobemaybelodgedtofindoutifthestudentgotscholarshiponhis/herownmeritorbyusinganyunfairmeans.ParentsandGuardiansofthe 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 alsoacompensationofRs.10Lacs,iftheinvestigatingcommitteeconcludesthatstudenthadnotsecuredthescholarshiponhis/herownmerits.

Therefore, if your child has got scholarship using unethical means please do not take admission at FIITJEE.

22. I/We,theparent/guardianand/orthestudent,herebyseverallyandjointlydeclareunambiguouslythatI/WehavereadandunderstoodalltheclausescontainedinthisEnrolmentform,AnnexureandDeclarationsandagreetoabidebythemwithoutanyreservationorambiguity.

23. I/We furtherdeclare that the studentnamedonpageno.3 is taking admission in theprogramasmentionedonpage3havingconsideredeverythingmaterial,onhis/herownsweetwillaftergivingdueconsiderationtorigorsoftime,distanceandstudiesaheadandwiththepermissionoftheFather/Mother/LegalGuardianwithoutanycoercionfromanyside.FurtherI/Weunderstandthatthestudentisrequiredtoworkhardtoattaintheaveragestandardofthebatchallottedinordertocopeupwithstudiesandputinextraeffortsiflaggingbehindinanysubject/topic.

24. I/Wefurtherundertaketoensurethatcheques/draftsincludingpostdatedchequesifanygivenbyuswillbehonoredbyourbankers.Intheeventofthesecheques/draftsbeingdishonored,FIITJEEisatlibertytoinitiateanyactionagainstusincludinglegalproceedingsundersection138ofNegotiableInstrumentsActorotherappropriatelaw.

25. IknowthatregisteredofficeofFIITJEELtd.issituatedatNewDelhi.

26. I promise to abide by all rules and regulations of FIITJEE declaration, in letter and spirit.

27. In the event of any dispute between the parties 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 FIITJEE Ltd. The arbitration proceedings shall beconductedinaccordancewiththeprovisionsoftheArbitration&ConciliationAct,1996andstatutorymodificationthereof&rulesmadethereunder.ItisfurtheragreedthatinspiteofthefactthattheSoleArbitratormaybeknowntoanyoftheDirectorsorshareholdersandthathemayhavebeendealingwiththeCompanyorhadoccasiontodealwithanymatterofthisagreementshallnotdisqualifyhim.EveniftheArbitratormayhaveexpressedopinioninsimilarmatterearliershallalsonotrenderhimdisqualified.Thearbitratorsoappointedshallnotbeincapacitatedfor 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.Thedecisionofthearbitratorshallbefinal&bindingonbothparties.ThevenueofArbitrationshallbeDelhi/NewDelhionly.

28. Subject to clause27 above, I/We (the student and theFather /Mother / LegalGuardian)understand that in caseof any legal dispute, thejurisdictionwillbeanappropriatecourt/foruminDelhi/NewDelhionlyandI/Weshallnottakerecoursetosuchanactioninanyothercourt/forumoranywhereelse.IncaseIdo,Ishallinformtherelevantcourt/forumregardingthisjurisdictionconstraint.

29. Ihavereadtheabovecarefullyandhaveunderstooditclearly.I/WehavealsoreadthecurrentFIITJEEBrochurecarefullyandhaveunderstooditclearly.IhavekeptaphotocopyofallthepagesofthisenrolmentformincludingthisdeclarationandAnnexures“A”,“B”,“C”&“D”formyfuture reference and timely compliance.

Additional declaration for Integrated School Program Students only :

30. I/We(Studentandtheparent)am/arejoiningFIITJEE’sIntegratedSchoolProgramonlyaftersatisfyingmyself/ourselvesaboutthestructureofprogram.I’llfullyabidebytherulesandregulationsoftheschool.IalsounderstandthatintheeventIamexpelledfromtheschoolonany

disciplinarygroundI’llraisenoclaimfromFIITJEEforanyacademicand/orfinanciallossincludingcoursefee..


Name : _________________________________ Name : _________________________________

Date : __________________________________ Date : __________________________________

Place : __________________________________ Place : __________________________________


12

Enrolment Form

(DeclarationtobegivenbythestudentifFather/Mother/LegalGuardiandoesnotresideintheStudyCentreCity,neitherdoeshe/she haveanyLocalGuardian)

As my Father / Mother / Legal Guardian do(es) not reside at _______________________________________ and I have no Local

Guardian. I own all responsibility on their / his / her behalf.

Date : _________________________________ Student’s Signature : ________________________________

Place : _________________________________ Name : _______________________________________________

(To be struck off, if Not Applicable)

(DeclarationtobegiveniftheEnrolmentformisnotsignedbytheFather/Mother/LegalGuardianatthetimeofadmission)

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.

Date : _________________________________ Student’s Signature : ________________________________

Place : _________________________________ Name : _______________________________________________

(To be struck off, if Not Applicable)

For Office use only

ChecklistfortheAccountant/AdmissionCoordinator.

v NameoftheAccountant/AdmissionCoordinator: _____________________________________________________________

v TheApplicationformiscompleteinallrespectwithAnnexureA,B,CandDdulysignedbythestudentandtheparent.

v 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) : ______________________________________________________________________________

v Thecertificatespertainingtoscholarshipareattached.

v 6 passport size and one stamp size photograph are attached.

v Latepaymentcharges/Admin.chargesdulycalculatedandcollected.

v Thefeechargedhasbeendulymatchedandverifiedwiththefeebrochure.

v SignaturesonPDCsandonAnnexureBandCaresame.

v IsthestudentjoiningasaHosteller?IfyesdetailsoftheLocalGuardianareprovided.

v The student has been offered the admission after selection in Admission test only.

DeclarationbytheAccoutant/AdmissionCoordinator.

IhaveverifiedtheentireEnrolmentformandcheckedallthepointsmentionedabove.TheEnrolmentisrecommended.

Date : _______________________ Place : _________________________ SignatureoftheAccount/AdmissionCoordinator


13

Enrolment Form

Program NameProgram

Code

For Admission in Class 6th

LittLe Genie - One Year Foundation Program - Regular Week Contact Classes 6051

LittLe Genie - One Year Foundation Program - Sunday Contact Classes 6053


UDAYA Plus - two Year integrated School Program 7010

UDAYA - two Year Classroom Program - Regular Week Contact Classes 7051

UDAYA - two Year Classroom Program - Weekend Contact Classes 7052

UDAYA - two Year Classroom Program - Sunday Contact Classes 7053


UDAYA - One Year Classroom Program - Regular Week Contact Classes 8051

UDAYA - One Year Classroom Program - Weekend Contact Classes 8052

UDAYA - One Year Classroom Program - Sunday Contact Classes 8053


SUPReme - Four Year integrated School Program for Jee (Advanced) 9020

AtHenA - Four Year integrated School Program for Jee (main) 9022

Four Year Classroom Program for Jee (Advanced) - Regular Week Contact Classes 9061

Four Year Classroom Program for Jee (Advanced) - Weekend Contact Classes 9062

Four Year Classroom Program for Jee (Advanced) - Sunday Contact Classes 9063

Four Year Classroom Program for Jee (main) - Regular Week Contact Classes 9071

Four Year Classroom Program for Jee (main) - Weekend Contact Classes 9072

Four Year Classroom Program for Jee (main) - Sunday Contact Classes 9073

LiBeRtY - Four Year integrated School Program for Admission to World’s top Universities 9021

Four Year Classroom Program for Admission to World’s top Universities 9042


three Year Classroom Program for iit-Jee - Regular Week Contact Classes 1061

three Year Classroom Program for iit-Jee - Weekend Contact Classes 1062

three Year Classroom Program for iit-Jee - Sunday Contact Classes 1063

three Year Classroom Program for Admission to World’s top Universities 1042

Classroom / Integrated School Programs

Please affix the 2nd passport size colour


Please affix the 3rd passport size colour


Please affix the stamp size colour


Please submit 3 additional passport

size colour photographs with this

Enrolment Form

14

Enrolment Form

Program NameProgram

Code


PinnACLe - two Year integrated School Program for iit-Jee 1110

two Year Classroom Program for Jee (Advanced) - Regular Week Contact Classes 1151

two Year Classroom Program for Jee (Advanced) - Weekend Contact Classes 1152

two Year Classroom Program for Jee (Advanced) - Sunday Contact Classes 1153

two Year Classroom Program for Jee (Advanced) - Special Weekend Contact Classes 1154

two Year Classroom Program for Jee (Advanced) - Regular Week + Sunday Contact Classes 1155

two Year Classroom Program for Jee (main) - Regular Week Contact Classes 1171

two Year Classroom Program for Jee (main) - Weekend Contact Classes 1172

two Year Classroom Program for Jee (main) - Sunday Contact Classes 1173

two Year Classroom Program for Jee (main) - Special Weekend Contact Classes 1174

two Year Condensed Classroom Program for iit-Jee -Regular Week Contact Classes 1161

two Year Condensed Classroom Program for iit-Jee -Weekend Contact Classes 1162

two Year Condensed Classroom Program for iit-Jee - Sunday Contact Classes 1163

GOLDen BRiDGe - two Year integrated School Program for Admission to World’s top Universities 1141

two Year Classroom Program for Admission to World’s top Universities 1142


One Year Classroom Program for Jee (Advanced) - Regular Week Contact Classes 1251

One Year Classroom Program for Jee (Advanced) - Weekend Contact Classes 1252

One Year Classroom Program for Jee (Advanced) - Sunday Contact Classes 1253

One Year Classroom Program for Jee (Advanced) - Regular Week + Sunday Contact Classes 1254

One Year Classroom Program for Jee (main) - Regular Week Contact Classes 1271

One Year Classroom Program for Jee (main) - Weekend Contact Classes 1272

One Year Classroom Program for Jee (main) - Sunday Contact Classes 1273

One Year Classroom Program for Jee (main) - Regular Week + Sunday Contact Classes 1278

USA UnivQuest - One Year Classroom Program 1242

Special Weekend Classroom Program for iit-Jee 1262

intensive Contact Program for iit-Jee 1281

Super Rank enhancement Classroom Program for iit-Jee 1282

Crash Course for Jee (main) 1286

For Admission After Class 12th

One Year extended Classroom Program for Jee (Advanced) - Regular Week Contact Classes 1351

One Year Classroom Program for Jee (main) - Regular Week Contact Classes 1371

One Year Classroom Program for Jee (Advanced) - Regular Week Contact Classes 1361

Special Classroom Program (for ex-FiitJeeians) 1362

intensive Contact Program for iit-Jee 1381

Super Rank enhancement Classroom Program for iit-Jee 1382

Crash Course for Jee (main) 1386

Classroom / Integrated School Programs

FIITJEE School Network

* Th

is m

ap is

not

to sc

ale

FIITJEE Associate Schools

FIITJEE Junior Colleges

Delhi (South)

Delhi (Punjabi Bagh)

Delhi (east)Noida (Delhi-nCR)

Gurgaon (Delhi-nCR)

Faridabad (Delhi nCR)

Ghaziabad (Delhi-nCR)

Lucknow

Chandigarh

Jaipur

Bhopal

Gwalior

Vadodara

Indore

Nagpur

Pune

Mumbai (Kandivali)Mumbai (Chembur)

KanpurAllahabad

Gorakhpur

Varanasi

Patna

Kolkata

Bhubaneswar

RanchiBokaro

And

AmAn

And

nico

bAr

LAkshAd

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(ind

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BhilaiRaipur

Coimbatore

Kochi

FIITJEE Junior College Visakhapatnam

FIITJEE Junior Colleges Hyderabad (Saifabad) Hyderabad (Dilshukhnagar) Hyderabad (Kukatpally)

FIITJEE Junior College Vijayawada

Chennai (Adyar)Chennai (Kilpauk)Chennai (Sriperumbudur)Chennai (KK nagar)

Bangalore

National Admissions Office :FIITJEEHouse,29-A,KaluSarai,SarvapriyaVihar,NewDelhi-110016

Ph.:011-46106000/10/13/15AllIndiaTollFreeNo.:1800114242Fax:011-26513942Web:www.fiitjee.com

L I M I T E D

* Th

is m

ap is

not

to sc

ale

Delhi (South)

Delhi (Punjabi Bagh)

Delhi (east)

Meerut

Lucknow (Gomti nagar)Lucknow (Aashiana)

Kanpur

Allahabad

VaranasiPatnaDhanbadBokaro

Durgapur

Bhubaneswar

Raipur

Bhilai

Shaktinagar NTPC

VisakhapatnamVijayawada

Kochi

Bangalore

Pune

Nagpur

Vadodara

Indore

GwaliorBhopal

Amritsar

Chandigarh

Jaipur (J.L.n. marg)Jaipur (Vaishali)

Coimbatore

Chennai (nungambakkam)Chennai (Kilpauk)Chennai (Adyar)Chennai (Sriperumbudur)Chennai (KK nagar)

Kolkata (Rabindra Sadan)Kolkata (Ultadanga-Salt Lake)

Ranchi (Lalpur)Ranchi (SOP Doranda)

Gorakhpur

Delhi (Rohini)Delhi (Janakpuri)Delhi (Dwarka)Noida (Delhi-nCR)Gurgaon (Delhi-nCR)Faridabad (Delhi-nCR)Ghaziabad (Delhi-nCR)

Hyderabad (Saifabad)Hyderabad (Dilshukhnagar)Hyderabad (Kukatpally)

Mumbai (Dadar)Mumbai (Chembur)Mumbai (Kandivali)Mumbai (Andheri)Mumbai (navi mumbai)Mumbai (thane)

And

AmAn

And

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FIITJEE Centre Network

Enro

lmen

t Fo

rm w

.e.f.

11th

Nov

ember

, 2012

Download - Enrollment Form Fiitjee

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