IEE Registration Form

Student Registration Form
Choice of Study Centre*

Girish ParkHowrahPark Street
STUDENT INFORMATION

Please ensure to fill all the mandatory fields carefully . This information will be printed on your ID Card
Preferred Mode of Study *

Offline - Classroom TeachingOnline - Virtual Mode
Take Your selfie
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState

Pin CodeCountry
Student Mobile Number (Calling)*
Format: 00000 00000.
Mobile Number*
Format: 00000 00000.
Student Email
Courses*
Declaration by Candidate " I hereby agree to follow and abide by all the rules and regulations laid by the institute from time to time" . *
PARENT INFORMATION
Name

First NameLast Name
Email
example@example.com
Phone Number*
Please enter a valid phone number.Format: 00000 00000.
School Information

Enter your Class 12 School Details
Name of School Attended in Class 12*
UID / Roll No ( Class 12 Exam ) Optional
Stream

ScienceArtsCommerceOthers
Upload your Class 10 marksheet
Please verify that you are human*
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Student Registration Form