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Career Institute: Registration Form

The document appears to be a registration form for an educational institute called Evolution Career Institute. It requests basic student information like name, DOB, gender, course applying for, past academic performance, contact details, and includes declarations for accuracy of information and adherence to institute rules. Signatures of student and guardian are also required.

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Er Purushottam Pal
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111 views2 pages

Career Institute: Registration Form

The document appears to be a registration form for an educational institute called Evolution Career Institute. It requests basic student information like name, DOB, gender, course applying for, past academic performance, contact details, and includes declarations for accuracy of information and adherence to institute rules. Signatures of student and guardian are also required.

Uploaded by

Er Purushottam Pal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Evolution

Learn to do... Application Form No.


Learn to be...
Learn to achieve...
Career institute
Registration Form Session 2017-18
Instructions: Paste Your recently
1. Use only Black/Blue Ball point/Gel Pen to complete the Registration form taken passport size
2. Use only CAPITAL LETTERS of English language to complete the Registration form color photograph
3. Tick ( ) in the appropriate box wherever box like this is given (3.5cmX4.5cm) by
applying gum only.
Name of the Applicant:(leave the box blank between first, middle & last name) Do not staple the photo

Fathers Name:(leave the box blank between first, middle & last name)

Mothers Name:(leave the box blank between first, middle & last name)

Date of D D M M Y Y Y Y

Birth Gender M F Category


GEN OBC SC ST PD Signature
Course you are applying for Classroom contact Programme
Academic Educational Courses Declaration for Fee
S.No. Course Name Class Type Fee Details:-
1. 8/9/10 Science C Y 1. Total Fee___________________________________________
2. 8/9/10 Mathematics C Y 2. Tuition Fee_________________________________________
3. 11/12 Physics C Y 3. Study Material Fee___________________________________
4. 11/12 Chemistry C Y 4. Scholarship Amount_________________________________
5. 11/12 Mathematics C Y 5. Net Fee Payable_____________________________________

6. 11/12 Biology C Y
Signature of Guardian
7. JEE-Mains/Advance/NEET C Y

Parents Permanent Residence Address(Do not write your Fathers Name Here)
House No./Street

Area/Colony/Vill.

City/Town/P.O.

Tehsil/Taluka

District

State Country
Pin Code Telephone No.(Landline) 0 -

Mobile No. (Self) 0 Mobile No. (Parents) 0


E-mail

Emergency Mobile No.(other than Parents) Alternative Mobile No.(other than Parents)

Relationship Relationship

Mobile No. 0 Mobile No. 0

Have your real brother(s)/sister(s) ever studied in EVOLUTION? Yes No If Yes, provide the details in the table below:

Last Relationship Course


S.No. Name Evolution Roll No. Academic Session (Brother/Sister) Class Final Batch Examination Qualified
Name
1.
2.

How did you come to know about Evolution? (In the Source Details, write Newspaper/Magazine/Friend/Relative/Old Student's Name, address & Contact No.)
Past Performance in Previous Classes/Competitive Exams
Past Performance Year of
S.No. in Exams
Max. Marks Obtained Marks Percentage Name of School Qualification
Remarks (if any)

1. 8th Class
2. 9th Class
3. 10th Class

4. 11th Class

5. 12th Class
6. NTSE/KVPY
Olympiad
7. Other Examination

Applicants Latest School/College Details

Name Of School/College

Your Present Class/Stream

Parents/Guardians Occupation
S.No. Occupation S.No. Occupation S.No. Occupation
1. Agriculture 1. Law Practice 1. Private Service
2. Artist 2. Doctor 2. Teaching/Research
3. Business/Self-Employed 3. Engineer 3. Unemployed
4. Defence Services 4. Public/Govt. Service 4. Other

Declaration
I/We, the undersigned, hereby solemnly and truly declare and affirm that, the information provided by me/us in the application form (as well as
the copies of examination forms, qualification, etc. as also cheques, demand drafts submitted to the institutes towards the payment of course fee)
is true and correct. Further I/We have understood and agree that any misrepresentation or concealment of facts, will justify the denial/cancellati-
on of undersigned students admission and expulsion from the institute at any stage of the academic session. Further, if the undersigned student
is admitted to the institute for the study course applied by him/her. I/We promise to abide by all the rules & regulations and disciplinary norms
of the institute as long as the institute undersigned student remains a registered student of Eolution Career Institute.
I/We also hereby declare that while being an enrolled student of Evolution Career Institute, the undersigned student will be responsible for provi-
ding relevant details of all the competitive examinations (in the form of true copies of the application form of the relevant examinations) in which
he/she will be appearing in the future by the virtue of coaching or academic support from the institute. Further, I/We, hereby give our fee consent
to the institute for using the result, photograph & testimonials of he undersigned student, in any form, for bits growth strategies and development
plans, if the undersigned student, succeeds in any of the competitive examinations through coaching and academic support from Evolution Career
Institute at any point of time during academic session 2017-2018, and will never have objection for it.

Signature of one of the parent/guardian Signature of Student

Date: Place: Date: Place:

If signed by Guardian
Relationship Contact No.
Write his/her Name

Performance of Student (for office use only)


Examinations Max. Marks Marks Obtained Percentage General Ranking Remarks(if any)

Term Test 1

Term Test 2

Term Test 3

Term Test 4

School Examination

Competitive Examination

NOTE: In case of any legal disputes, the jurisdiction of court of Udaipur (Rajasthan) shall be appicable. Copyright@Evolution

Head Office:- Evolution Career Institute, Near K.V. No. 1, C-Class, Pratapnagar Tehsil-Girwa District-Udaipur, State-Rajasthan, Pin-313001
Contact No.-8955686073, 9610972410, 9413557948;Email us-evolutioncareerinstitute@gmail.com |Web- www.evolutioncareerinstitute.wordpress.com

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