JITO ENGINEERING AND MANAGEMENT PROGRAMME

JITO ENGINEERING AND MANAGEMENT PROGRAMME JEMP

JITO IIT Learning Center, KOTA (419 NEW RAJIV GANDHI NAGAR, KOTA)
APPLICATION FORM

PLEASE SPECIFY MOBILE NUMBER FOR CORRESPONDANCE
*Online Test is started conducting at KOTA Hostel
STUDENT DETAILS
(All the particulars must be filled in by the candidate in CAPITAL letters)
Upload Photo*

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Candidate’s Name*

First NameMiddle NameLast Name
Father’s Name*

First NameMiddle NameLast Name
Mother’s Name*

First NameMiddle NameLast Name
PRESENT ADDRESS *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PERMANENT ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
STUDENT’S MOBILE NO*
AADHAR CARD NO*
Student's E-mail*
Parent's E-mail*
example@example.com

ACADEMIC PERFORMANCE OF THE CANDIDATE*

	PCM %	OVERALL %	NAME AND ADDRESS OF INSTITUTE/ SCHOOL/COLLEGE	BOARD
X
XI
XII

JEE EXAM PERFORMANCE*

	YEAR	RANK (MARKS)
JEE MAIN
JEE ADVANCE

OTHER ACHIEVEMENTS DETAILS * (NTSE/NSTSE/OLYMPIADS/KVPY/OTHER)

	NAME OF EXAM	RANK/ MARKS
1
2

PERFORMANCE IN MAIN COACHING INSTITUTE

	NAME OF THE INSTITUTE	ENTRANCE TEST PERFORMANCE (IF APPEARED)
1
2

ANY SCHOLARSHIP, IF GRANTED BY COACHING INSTITUTE

	NAME OF THE INSTITUTE	ENTRANCE TEST PERFORMANCE (IF APPEARED)
1

Do you require scholarship under the category of ‘Meritorious Economically Weaker’ category?*

YesNo
Reason

STUDENT’S PARENT’S DETAILS*

Whether any other family member like brother / sister is and earning member. If yes, their annual income*
In Rupees
TOTAL FAMILY INCOME *

LOCAL REFERENCE OF TWO PERSON WITH MOBILE NUMBER

	Name	Mobile No	Address
1
2

ATTACHMENTS

MARKS SHEETSPHOTO COPIES OF CERTIFICATES OF OTHER ACHIEVEMENTSAADHARID PROOFPHOTOS (2 NOS.)ITR Copy
MARKS SHEETS*

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PHOTO COPIES OF CERTIFICATES OF OTHER ACHIEVEMENTS*

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AADHAR*

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PHOTOS (2 NOS.)*

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ID PROOF*

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ITR Copy

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Important Instructions

1. Candidate should preferably fill-up Google form before coming to kota.

2. Field like result of examination at Coaching center may be kept blank, which can be filled up, when student visit hostel at kota

3. If any student does not want scholarship, he may keep parent income field blank.

4. Admission to JEMP hostel is subject to test and interview

5. Candidate must bring original, copies of mark sheet and certificates.

Declaration:

1) I, hereby, declare that all statements and entries made in this application form are true, complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found false or ineligibility being detected any time, action can be taken against me by Management.

2) 1, confirm that I will follow all the rules & regulations prescribed by JITO Engineering and Management Programme and in case of any violation of any of the rules and misconduct, management would have absolute right to take disciplinary action against me.
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