admission cum scholarship test registration formcatapult (for students studying in ix, moving to...
TRANSCRIPT
STREAM OPTED FOR
GENESIS (For students studying in Class VIII, moving to Class IX in 2014)
CATAPULT (For students studying in IX, moving to Class X in 2014)
GROUND ZERO (For students studying in Class X, moving to Class XI in 2014)
COUNT DOWN (For students studying in Class XI, moving to Class XII in 2014)
REBOOST FOR JEE ADVANCED (For students in Class XII, appearing in XII board in 2014)
RESTART FOR JEE MAIN (For students in Class XII, appearing in XII board exam in 2014)
MAITS FOR JEE MAIN (For XII studying and XII passed students)
MAITS FOR JEE MAIN & ADVANCED (For XII studying and XII passed students)
SCP (For students in Class XII, appearing in XII board in 2014)
SCP (XII pass students)
FOUNDATION ENGINEERING MEDICAL
MEDICAL GROUND ZERO (For students studying in Class X, moving to Class XI in 2014)
MEDICAL COUNT DOWN (For students studying in Class XI, moving to Class XII in 2014)
MEDICAL REBOOST (For students in Class XII, appearing in XII board in 2014)
MAITS FOR AIPMT (For XII studying and XII passed students)
MAITS FOR AIPMT & AIIMS (For XII studying and XII passed students)
MEDICAL SCP (For students in Class XII, appearing in XII board in 2014)
MEDICAL SCP (XII pass students)
STREAM OPTED FOR
GENESIS (For students studying in Class VIII, moving to Class IX in 2015)
CATAPULT (For students studying in IX, moving to Class X in 2015)
GROUND ZERO (For students studying in Class X, moving to Class XI in 2015)
COUNT DOWN (For students studying in Class XI, moving to Class XII in 2015)
REBOOST FOR JEE ADVANCED (For students in Class XII, appearing in XII board in 2015)
RESTART FOR JEE MAIN (For students in Class XII, appearing in XII board exam in 2015)
MAITS FOR JEE MAIN (For XII studying and XII passed students)
MAITS FOR JEE MAIN & ADVANCED (For XII studying and XII passed students)
SCP (For students in Class XII, appearing in XII board in 2015)
SCP (XII pass students)
FOUNDATION ENGINEERING MEDICAL
MEDICAL GROUND ZERO (For students studying in Class X, moving to Class XI in 2015)
MEDICAL COUNT DOWN (For students studying in Class XI, moving to Class XII in 2015)
MEDICAL REBOOST (For students in Class XII, appearing in XII board in 2015)
MAITS FOR AIPMT (For XII studying and XII passed students)
MAITS FOR AIPMT & AIIMS (For XII studying and XII passed students)
MEDICAL SCP (For students in Class XII, appearing in XII board in 2015)
MEDICAL SCP (XII pass students)
AIPMT • AIIMS • State Level PMT
PLEASE FILL YOUR DETAILS IN BLOCK LETTERS.
PERSONAL DETAILS
Name
Date of Birth
Phone (STD)
Father Occupation
Email : (If you are sending registration form by post, it’s must to give e-mail id, so that you can receive the Admit Card through e-mail)
Gender
Male Female
Mobile Number (DND Free) [Essential for result]
Designation
AFFIX
PASSPORT SIZE
PHOTOGRAPH
(BY STUDENT)
FOR OFFICE USE ONLY
Registration No.
Course...................................... Counsellor's Sign........................................................
TEST CENTRE OPTED FOR
Father's / Guardian's Name
Phone (STD) Mobile Number (DND Free)[Essential for result]
If parent is Teacher (School Name & Address)
Category
General OBC(NCL) SC/ST PH
REGISTRATION FORM
ADMISSION CUM SCHOLARSHIP TEST
BHAGALPUR
PURNEA
MUZAFFARPUR
MOTIHARI
GAYA
DARBHANGA
SITAMARHI
PATNA: BORING ROAD
CHAPRAKANKARBAGH
SIWAN
OTHER
CORPORATE OFF: PARUSLOK, ABOVE TVS SHOWROOM, BORING ROAD CROSSING, PATNA-01
MENTORS EDUSERV
JEEKVPYNTSE, OLYMPIAD
Signature of the StudentsCompulsory
Authorised SignatoryCompulsory
ADMISSION CUM SCHOLARSHIP TEST AIPMTAIIMSSTATE PMT
AIPMT • AIIMS • State Level PMT
www.mentorsedu.comDIVISIONS OF MENTORS EDUSERV
Keep this ADMIT CARD safely as it is compulsorily required at the time of admission
Exam Centre (Town)
Name of Student
Father's Name
Registration No.
Test Date
Date :
Place : Applicant's Signature
Terms & Conditions
1. Admission to all programs is at the sole discretion of the management of Mentors Eduserv.
2. All matters are subject to the exclusive jurisdiction of courts in Patna only.
Declaration :
I have read and shall abide by the terms & conditions of the institute. I hereby declare that the information provided by me in this Registration Form is correct to the best of my knowledge.
School affiliated to :
Details of last Examination passed
CBSE ICSE Others (Please specify)......................................................
Class School/Board Year of Passing Grade/Percentage (%) securedin Science & Maths/PCS
CGPA/AggregatePercentage (%)
City /Town
Class Studying in 2014 VIII IX X XI XII XII Pass
Details of School studying in/last attendedSchool Name
Address
State
ACADEMIC DETAILS
CORRESPONDENCE ADDRESS
City /Town
State
Pin
Facilities Required (if any) : Hostel Transport (Select places only)
How did you come to know about Mentors (specify) .......................................................................................................................................
CORPORATE OFFICE: PARUSLOK, ABOVE TVS SHOWROOM, BORING ROAD CROSSING, PATNA-800 001
KANKARBAGH OFFICE: A-10, 1st FLOOR, ABOVE BANK OF BARODA, PATRAKAR NAGAR, PATNA-20
CALL: 0612-3223681/2•7544015993/6/7
JEEKVPYNTSE, OLYMPIAD
AIPMTAIIMSSTATE PMT
AIPMT • AIIMS • State Level PMT
QUALIFIED IN : IMO (1st Stage) IMO (2nd Stage) NSO (1st Stage) NSO (2nd Stage) NSEJS (1st Stage) NSEJS (2nd Stage)
NTSE (State Level) NTSE (National Level) RMONSTSE KVPY JEE-Main Rank
JEE-Advance Rank AIPMT Rank Other PMT Rank
CORPORATE OFF: PARUSLOK, ABOVE TVS SHOWROOM, BORING ROAD CROSSING, PATNA-01
MENTORS EDUSERV
CALL: 0612-3223681/2•7544015993/6/7
STREAM OPTED FOR
GENESIS (For students studying in Class VIII, moving to Class IX in 2015)
CATAPULT (For students studying in IX, moving to Class X in 2015)
GROUND ZERO (For students studying in Class X, moving to Class XI in 2015)
COUNT DOWN (For students studying in Class XI, moving to Class XII in 2015)
REBOOST FOR JEE ADVANCED (For students in Class XII, appearing in XII board in 2015)
RESTART FOR JEE MAIN (For students in Class XII, appearing in XII board exam in 2015)
MAITS FOR JEE MAIN (For XII studying and XII passed students)
MAITS FOR JEE MAIN & ADVANCED (For XII studying and XII passed students)
SCP (For students in Class XII, appearing in XII board in 2015)
SCP (XII pass students)
FOUNDATION ENGINEERING MEDICAL
MEDICAL GROUND ZERO (For students studying in Class X, moving to Class XI in 2015)
MEDICAL COUNT DOWN (For students studying in Class XI, moving to Class XII in 2015)
MEDICAL REBOOST (For students in Class XII, appearing in XII board in 2015)
MAITS FOR AIPMT (For XII studying and XII passed students)
MAITS FOR AIPMT & AIIMS (For XII studying and XII passed students)
MEDICAL SCP (For students in Class XII, appearing in XII board in 2015)
MEDICAL SCP (XII pass students)
INSTRUCTIONS• Carrying admit card for Test is a must.• Be seated in the examination hall 15 minutes before the scheduled start time of the test.• You will NOT be admitted after 15 minutes of the scheduled start time of the test.
• You will NOT be permitted to leave before the scheduled closing time of the test.• Use only Black / Blue Ball Pen to fill the most appropriate bubble in the OMR sheets.• Use of calculators, log tables, electronic gadgets are NOT permitted in the examination hall.• Use of unfair means will lead to the cancellation of candidature.