ADMISSION CUM SCHOLARSHIP TEST REGISTRATION FORMCATAPULT (For students studying in IX, moving to Class X in 2014) GROUND ZERO (For students studying in Class X, moving to Class XI

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



















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


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


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



















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.

Documents

ADMISSION CUM SCHOLARSHIP TEST REGISTRATION FORMCATAPULT (For students studying in IX, moving to Class X in 2014) GROUND ZERO (For students studying in Class X, moving to Class XI