Student Name Date of Birth School/College If working (orgn) Father/Husband Name Address: Designation: Profession:_____________ Sign: Male/Female: Qualification:

___________ PHOTO

Parent Ph: Parent Email:

Student Ph.: Student Email id:

Brothers/Sisters Name

Standard / Qualification

School / college/ Organization

Have you/your family members ever studied in VIKASYOJANA EduCare? No

Name

Course

Receipt No.

Myself- 15% Academic Year

Yes

Family Member- 10% Certificate No.

How do you come to know about VEduCare?

POSTERS

BANNERS

FRIENDS

OTHERS: _____________________

COURSE OPTED
COMPUTER COURSES
MS OFFICE TALLY INTERNET OTHERS: ________________________________

ENGLISH COURSES
SCHOOL / COLLEGE TUITIONS

FOUNDATION

SPOKEN ENGLISH

OTHERS: ___________________________

BOARD: ____________________

MEDIUM: ______________ CLASS: ______ STREAM: _______

SUBJECTS: 1. ________________ 2. _______________ 3. _________________ ALL

SCHOOL / COLLEGE

STUDY/MEMORY SKILLS NAVODAYA/SAINIK

NOTES NTSE

WORKSHOP JEE/NEET

OTHERS: ______________ ENTRANCE: ____________

ADVANCED COACHING

IAS/KAS: CSAT/PRELIMS

MAINS

GS

OPT-1

OPT-2

INTERVIEW

COMPETITIVE EXAMS

OTHERS(specify): 1. _________________________

2. ______________________________

Mention the names of 3 persons who have had an influence on your academics so far.
Name 1. 2. 3. Relation Contact No. Email ID ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

Rules and Regulations

1. 2. The Director/Centre Head of the VIKASYOJANA EduCare reserves the right to refuse admission to any candidate without assigning any reason thereof. Discipline in all sorts is compulsory and binding. Indiscipline in any form is not acceptable and is dealt with sternly. The Director/HOI has the right to cancel the admission of any student at any time without assigning any reason thereof. No refund of fees paid is entertained in such cases. Discontinuation at any stage must be permitted by the Director/HOI. However, no refund of fees is entertained. Fee must be paid in full/installments within the stipulated time/period as would be fixed by the Director/HOI. Delay in payment of fee results in imposing fine of Rs 10/-per day/course for the maximum period of 10 days and thereafter admission of such defaulters shall be treated as cancelled. Students request to change of batch or time or Course is not permitted. Any change in address or phone number must be communicated immediately by the student. The management enjoys the all rights to bring any change in rules and regulations, course, fee structure, curriculum, batch, timing, etc at any time without the prior notice and without assigning any reason thereof. Such changes are binding to all the concerned.

3. 4.

5. 6. 7.

8. 9.

Any student found damaging the property of VIKASYOJANA EduCare, shall have to replace the article or pay for the replacement
All disputes are subject to judicial jurisdiction of Koppal Court only.

I hereby undertake to abide by the rules/regulations of VIKASYOJANA EduCare during the period of my/my wards coaching. I understand that the Director/HOI has the full authority to cancel my/my wards admission at any time without assigning any reason thereof. Indiscipline or non-payment of fee etc shall not entitle me/my ward to continue in the institute. I also understand that fee once paid is not refundable under any circumstance. I accept and abide by the conditions mentioned above and those would be enacted /adopted from time to time. Sir/Madam, I have read all the Rules and Regulations and will sincerely abide by them, if admitted. Signature of the Student Full Name: _________________________________ Date: ___________________ Sir/Madam, My ward will abide by all the Rules and Regulations. I stand surety for him/her. I would like to have his/her Attendance and Test/Exam Record sent to me by Email or SMS. Signature of the Student Full Name: _________________________________________ Date: ___________________

DECLARATION

Note: Students and Parents/Guardians Signatures are a must, without which the Form will not be accepted. For the student who has attained 18 years of age, Parents/Guardians Signature may not be compulsory.

OFFICE USE ONLY

Name: Ph:

Course: .. Receipt No: . Receipt No: .

Batch: Date: .. Date: ..

Course Fee: Balance: ... Balance: ...

Adm.No:.. Initial: .. Initial: ..

___________________________

_____________________________

Signature of Adm. in charge Date:

Signature of the Director/HOI Date: ..