Post on 08-Feb-2016
description
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.
3
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 : _________________________
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 : ___________________________
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 : ________________________
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 : ___________________________
Mailing Address : _______________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
_________________________________________________________________________________ Pin: _________________________________
(d) Details of the Sibling(s) (if applicable)
1. Name : _______________________________________________________________________________________
Class studying in : ___________________________ Enrolment No. (if enrolled with FIITJEE) :_________________________
2. Name : _______________________________________________________________________________________
Class studying in : ___________________________ Enrolment No. (if enrolled with FIITJEE) :_________________________
3. Name : _______________________________________________________________________________________
Class studying in : ___________________________ Enrolment No. (if enrolled with FIITJEE) :_________________________
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)
5
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.
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 : ______________________________________
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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.
SignatureoftheStudent Father/Mother/LegalGuardian’sSignature
Name : ____________________________________________________ Name : ________________________________________
EnrolmentNumber(for office use only) : __________________________ Address : _______________________________________
Date : _____________________________________________________ ________________________________________________
I have retained photocopy of this document for my reference before submitting it at FIITJEE.
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®ulationsofFIITJEEorFIITJEE’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.
Student’s Signature Signature of Father / Mother / Legal Guardian
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..
Student’s Signature Signature of Father / Mother / Legal Guardian
Name : _________________________________ Name : _________________________________
Date : __________________________________ Date : __________________________________
Place : __________________________________ Place : __________________________________
DECLARATIONS / UNDERTAKINGS
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
DECLARATIONS / UNDERTAKINGS
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
For Admission in Class 7th
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
For Admission in Class 8th
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
For Admission in Class 9th
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
For Admission in Class 10th
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
photograph of the student here
Please affix the 3rd passport size colour
photograph of the student here
Please affix the stamp size colour
photograph of the student here
Please submit 3 additional passport
size colour photographs with this
Enrolment Form
14
Enrolment Form
Program NameProgram
Code
For Admission in Class 11th
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
For Admission in Class 12th
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
weep
(ind
iA)
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
nico
bAr
LAkshAd
weep
(ind
iA)
FIITJEE Centre Network
Enro
lmen
t Fo
rm w
.e.f.
11th
Nov
ember
, 2012