Admission Form - ACERT - No.1 Coaching Institute

Admission Form for Coaching Classes

Name *

First

Middle

Last

Father's / Mother's/ Husband's Name *

First

Middle

Last

DOB *

Gender *

Male
Female
Other

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Mobile *

Educational Qualification *

Name of University/College/ School *

Year of Passing *

Coaching Applied For *

Branch for coaching *

Subject of Coaching *

Mode of Coaching *

4 classes weekly i.e. total 8-12 hrs weekly for both classroom and online batches.

Course Type *

Batch Option *

Course Combination *

Steps of Examination *

Type of Admission

Study Materials and Practice Questionares

Hostel Facility Requirement

Document Upload: *

(Max 1 MB) (Birth Certificate/10th Certificate, Bachelor/Master degree/ Ph.D degree Certificate altogether as pdf file)

Photo Upload: (Your Image) *

(Max 1 MB) Passport size Photo

Source of Information

Name of Source/ Reference

Write website name/ person name where you have got information about us.

Declaration (Check all the boxes compulsorily) *

All the above information are correct as per my knowledge.
I will not discontinue the course in midway without proper reason.
I will not ask for refund as the course fee is non-refundable at any time.
I am liable to pay the full course fee as per ACERT's rules.
I am liable to pay penalty for delayed installment payment.
I will provide post-dated signed cheques for installments within 15 days of admission.

Date of application *

DD/MM/YYYY

Signature: *

Phone