Student's Name
Father's Name
Occupation
Designation
Category
Select
GEN
OBC
SC
ST
Studying Class
Select
Class 07
Class 08
Class 09
Class 10
Class 11
Class 12
Dropper
Parent's Annual Income
Select
< 5 Lakhs
5-10 Lakhs
10-20 Lakhs
> 20 Lakhs
Date of Birth
Gender
Female
Male
Other
Name of School
Other School Name
Board Affiliated To
CBSE
ICSE
State Board
OTHER
Specify Board Name(if other)
Percentage/Grade (Last Exam.)
Achievements (NTSE/Olympiads/School/Other's)
Best Friend (Name)
Best Friend (Mobile No.)
Are you old student of MOMENTUM/SCOREMAX?
Yes
No
Center Name
Select
MOMENTUM WRIGHT TOWN
SCOREMAX ADHARTAL
SCOREMAX RAMPUR
SCOREMAX RANJHI
SCOREMAX TILHARI
SCOREMAX VIJAY NAGAR
SCOREMAX WRIGHT TOWN
Residential Address
City
Pincode
Parent Mobile No.
Student Mobile No.
Whatsapp Mobile No.
Phone (Resident) with Stdcode
Student Email
Parent Email
Which Competitive Exam(s) do you paln to take?
ENGINEERING
MEDICAL
OLYMPIAD
KVPY
NTSE
Could you share with us the name of a teacher who has specially influenced/motivated/generated interest in you to take future studies in Science
Name of Teacher
Subject
Mobile No.
Feedback about The Teacher
Your feedback will be used to reward three teachers who are favourite to students.
Save