APPLICATION FORM

PACE ACADEMY

Head Office

HIG - 189, Kanan Vihar Phase -I, Patia, BBSR

Email : mypaceacademyindia@gmail.com

A. COURSE PARTICULARS
DESIRE COURSE*
DESIRE UNIVERSITY / BOARD*
SESSION*
B. CANDIDATE’S PARTICULARS
NAME OF THE CANDIDATE*
NAME OF THE FATHER*
NAME OF THE MOTHER*
C. ADDRESS FOR COMUNICATION
C/O*
Q.NO / STREET*
AT / PO / PS*
VIA / NEAR BY DISTRICT*
STATE* PIN*
D. CANDIDATE’S DETAILS (*Write Yes / No if required)
E. EDUCATIONAL HISTORY
LEVEL NAME OF THE INSTITUTIONS BOARD/UNIVERSITIES REGD NO. / ROLL NO. %SECURED YEAR
SCHOOL
INTER/DIPLOMA
UG/B.TECH
PG
OTHER
F. COLOUM FOR PROFESSIONAL COURSE :
NAME OF THE COURSE
RANK IN STATE ENTRANCE (IF ANY)
METHODOLOGY - I / SPECIALISATION
METHODOLOGY - II / SUBJECTS
G. COLOUM FOR DISTANCE COURSE
NAME OF THE COURSE
DESIRE STREEM / SPECIALISATION
DESIRE SUBJECTS
Tick your enclosures
1.10th : Mark Sheet : Mark Sheet
2.Inter/Diploma : Mark Sheet : Mark Sheet : Migration
3.UG/B.Tech : Mark Sheets : Mark Sheet : Degree
4. PG : Mark Sheets : Mark Sheet : Degree
5.Other : CLC /T. C. : Conduct : Migration
: Caste : Resident : Photos
6.Payments : Cash : Cheque : DD
STUDENT’S / PARENT’S UNDERTAKING

I hereby declare that the above information are correct and true to the best of my knowledge and belief. I am well aware of PACE ACADEMY and its activities. I undertake that if any discontinuation, delay in payment & documentation, disobedience, cheating or any misconduct found during the course, my name will be eliminated from the institution. I do agree that all the course fees are nonrefundable in any circumstances. In case of discontinuance/ drop/ cancellation for any reason whatsoever I do agree to pay the entire amount of course fees. No other person or persons or organization will be responsible for this. I agree to obey all the instructions of the Organisation.