Catalyze Center for Learning
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STUDENT REGISTRATION FORM
Please fill the student enrollment form below:
     
Preferred
Country's Curriculum
Enter your Email ID *
Password *
Confirm Password *
Skype ID *
(If you do not have one, click here to register)
 
Personal Information  
First Name *
Last Name *
Gender
Age  (e.g. 15yrs)
Date of Birth  (e.g. dd/mm/yyyy)
Mother Tongue
Parent's Name *
Parent's Occupation
   
 
Address for communication
Address *
City *
State *
Country *
Pin Code / Zip Code *
Residence Phone No. *
Mobile No.
Parent's Mobile No.
Parent's Skype ID
Parent's Email ID *
   
 
School Details  
Name of the School
currently studying *
 
Enrollment for  
Board / University *
Class / Course *
   
One on One
coaching required
 
Note: Check this box if you want to be coached alone instead of one among a group of 4.
 
  Subjects* Days* Timings*  
   
   
   
   
   
         
  Note: Coaching for Commerce, Accountancy, Business Studies, Business Mathematics, Economics subjects are only for XIth and XIIth Standards. Coaching for Social Studies, English and Hindi subjects are for all Standards. (IVth to XIIth )
         
Please mention other subjects for which coaching is required, if not listed above:
 
Details of marks scored in previous competitive examination
(e.g.80/100, In case of Paper I/Paper II enter as 160/200) *
  Subject *        Marks *
 
 
 
 
 
 
     
  Aggregate Score
  Percentage of Marks
 
Upload your passport size photo *
Please upload an image of type JPG or GIF and dimension close to 135w x 150h.
Size not to exceed 200 KB.
 
Additional Information  
System Availability
Internet Connection
Knowledge in Word/Excel
Knowledge in PowerPoint
Knowledge in Chat Tools
Typing Speed
   
Remarks, if any
   
 
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