LEAD Talent Search Exam – LTSE 2015 SCHOLARSHIP-CUM-ADMISSION TEST - For Students passing 10th std in 2015

Date : Sunday, 12th April 2015. Exam Time : 10.00am – 12.30pm Reporting Time : 9.30am

Entrance Test for Admission to 2 Year Residential Program offered by Sl.

College

City

Gender

Coaching For

1 2 3 4 5 6

Alpine PU College M S Academy Shaheen PU College Shaheen PU College Shaheen Challenger Junior College Shaheen Crescent PU College

Bangalore Hyderabad Bidar Gulbarga Hyderabad Bangalore

Only Boys Only Boys Boys & Girls Boys & Girls Only Girls Only Girls

IIT-JEE / NIT + KCET Engineering IIT-JEE / NIT Karnataka & Kerala CET Med & Engg Karnataka & Kerala CET Med & Engg Karnataka & Kerala CET Med & Engg Karnataka & Kerala CET Med & Engg

APPLICATION FORM `

Please attach recent Passport size photograph

1. Applying For

No. of FREE Seats 10 30 50 30 20 07

Hall Ticket No.

Note to Students: 1. All fields are mandatory and to be filled in BLOCK letters. 2. Please provide complete and correct information. 3. Kindly submit the application to the District Coordinator before 5th April 2015. 4. Please carry a Pen, Pencil and Eraser for the Test. 5. The Exam Fee of Rs.30/- must be paid along with this application form.

: Alpine PU College, Bangalore ( ) M.S. Academy Junior College, Hyderabad ( ) Shaheen PU College, Bidar ( ) Gulbarga ( ) Hyderabad ( ) Shaheen Crescent PU College, Bangalore ( )

2. Name of the Student : __________________________________________________________________________________________ 3. Gender

: Male ( )

Female ( ) Date of Birth (DD/MM/YYYY) : ____________________________

4. Register / Hall Ticket No. of 10th Std Exam : _________________________________________________________________ 5. 10th Board

: SSLC ( ) CBSE ( ) ICSE ( ) NIOS ( ) Others ( ) _________________________________

6. Medium of Education till 10th : English ( ) Kannada ( ) Urdu ( ) Malayalam ( ) Other ________________ 7. Full Address

: ___________________________________________________________________________________________

_____________________________________________________________________________________________________________________ 8.

Phone No.

: ___________________________________________ Mobile No._________________________________

9. Email ID

: ___________________________________________________________________________________________

10. Father’s Name

: __________________________________________________________________________________________

PLEASE WRITE EMAIL ID IN CAPITAL LETTERS ONLY

(Guardian – In case of orphans)

11. Father’s Occupation : __________________________________________________________________________________________ ( Guardian – In case of Orphans)

12. Annual Income of Family from All Sources : _________________________________________________________________ 13. Is the Student eligible to receive ZAKAT Money for education ? Yes ( ) No ( ) 14. How did you come to know about LTSE 2015 ? Newspaper ( ) Poster ( ) Email ( ) SMS ( ) School ( ) WhatsApp ( ) Other ( ) ________________ _____________________________________________ Signature of Student with date

_____________________________________________ Signature of Father/Guardian with date

To know the Test Centre in your city or district, please visit www.leadtrust.in