FOUNDATION ACADEMY IIT PATNA, BIHTA CAMPUS

A unit of VIVASHWAN EDUCATIONAL AND WELFARE SOCIETY
E-mail ID: info@foundationacademyiitpatna.in
Website : www.foundationacademyiitpatna.in

Only Science Stream (PCB / PCM)

Student’s Name *

Date of Birth *

Blood Group *

Previous School attended *

Previous School Board *

Medium of Instruction *

Subject Studied in Grade X *

Percentage of marks obtained in preboard exam/AISSE exam *

Father’s Name *

Mother’s Name *

Present Address *

Permanent Address *

Contact Number *

Alternate Contact Number *

Aadhar Number *

Email ID *

Passport Size Photograph *