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Name

First

Middle

Surname

  

Address

Apartment/Bldg

Street

Area

 City
   
Pin State    
Phone
STD code Tel no    
Email  
Currently in Std If other  
Details of exams appeared / appearing for Name of exam Name of Board Name of school/college % secured in Maths/Sci Year of appearing
X
XII
Qualified for any of the following exams NTSE Maths Olympiad Physics Olympiad Chemistry Olympiad
Merit ranker in X or XII exams If yes, Merit rank  
Appearing for IIT-JEE in the year      
Have you appeared for before ? If yes, the year of appearing  
Did you Qualify for   ? If yes, AIR  
How are you preparing for ? Classroom Coaching Name of  the institute  

Correspondence Course

 Name of the institute  
Other Please Specify  
Are you appearing for IIT-JEE ? If yes, year of appearing  
Appearing for IIT-JEE in the year      
Have you appeared for IIT-JEE before? If yes, year of appearing  
Did you Qualify for IIT-JEE? If yes, AIR  
How are you preparing for IIT-JEE? Classroom Coaching Name of  the institute  

Correspondence Course

 Name of the institute  
Other Please Specify