MEDI-CAPS UNIVERSITY, INDORE

Faculty & Department: Computer Science and Engineering

General Details
1. Name :
2. Branch : ………… Enrollment No. :
3. DOB : ………Nationality :… Blood Group :
4. Adhar No. :
5. Present Address

…………………………………………………………………………….......……………………
Tel No………………………….Mob No
6. Permanent Address
……………………………………………………………….......……………………
7. Father’s/Guardian’s Names
8. Tel No…………………….Mob No E-Mail…
9. Mother’s/Guardian’s Names …………………… Occupation Professor Toyota
Tel No…………….Mob No…………………E-Mail……………
10. Yearly income of Parent/Guardian…………………………………
11. Details of Brother, Sisters and their Profession
1.
2. …………………………………………………………………………….......……………
3. …………………………………………………………………………….......……………
4. …………………………………………………………………………….......……………
12. Present address of parent/guardian
………………………………………………………………………….......……………………
Tel No………………….Mob No……………………E-Mail……………………………
13. Health Problem, if any
…………………………………………………………………………….......……………………
…………………………………………………………………………….......……………………

14. Hobbies/Interests/Extra or Co-curricular activities

………… ………………………………………………………………….......……………………
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15. Achievements (up to12thclass)

……………………………… ……………………………………….......……………………
…………………………………………………………………………….......……………………
16. Student Vision
…….......……………………
…………………………………………………………………………….......……………………
……………………………………………………………………………………………………..
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17. Student Mission

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18. Anti-ragging affidavit filled- Yes/No …………………

19. NAD registration- Yes/No ……………

20. NDL and Digi locker registration- Yes

21. Swayam/MOOC registration Yes

22. Connected to Medi-Caps through

Facebook Yes Twitter Yes inkedIn Yes nstagram Yes

YouTube Yes AccSoft Yes STL Yes

23. If Bus user, Bus No. yes If hosteller, Room No. NA

 Academic Details
1. Examinations Cleared

Exam. Branch Board/University Passi Divisio %

ng n marks/
Year CGPA
10th 81
12th /Diploma 59.8
Bachelor’s 9.6
Degree
Master’s
Degree
Admission through (JEE/Qualifying Exam) ……………12th qualifying exam……………………………
2. Co-curricular and extracurricular activities details including special achievements, if any
Semest Deta
er ils
I

II

III

IV

VI

VII

VIII

3. Internship / Industrial Training Detail

Duration Name of the Company Nature of Internship
4. Semester wise academic Record
Semester-I
Swayam/MOOC course details-…………………………………………………………………….
Cours Mi Mi End term Practi Attendan Quiz/ Assignments Remark
e d d marks/ cal ce s
Register Se Se Grade Mark %
ed mI m II s/ T P I I I I V
Ma Mar grade I I V
rks ks I

SGPA --------------------------- Credit ---------------------------------------

Semester-II
Swayam/MOOC course details -…………………………………………………………………….
Cours Mi Mi End term Practi Attendan Quiz/ Assignments Remark
e d d marks/ cal ce s
Register Se Se Grade Mark %
ed mI m II s/ T P I I I I V
Ma Mar grade I I V
rks ks I

Note- Use similar table if student opts MAKEUP semester

SGPA------------------- CGPA------------------ Credit -------------------------- Cumulative Credit----------------------

(If student is appearing in makeup semester, please note the detail in separate sheet.)
 Semester-III
Swayam/MOOC course details -…………………………………………………………………….
Cours Mi Mi End term Practi Attendan Quiz/ Assignments Remark
e d d marks/ cal ce s
Register Se Se Grade Mark %
ed mI m II s/ T P I I I I V
Ma Mar grade I I V
rks ks I

SGPA------------------- CGPA------------------ Credit -------------------------- Cumulative Credit----------------------

Semester-IV
Swayam/MOOC course details -…………………………………………………………………….
Cours Mi Mi End term Practi Attendan Quiz/ Assignments Remark
e d d marks/ cal ce s
Register Se Se Grade Mark %
ed mI m II s/ T P I I I I V
Ma Mar grade I I V
rks ks I

Note- Use similar table if student opts MAKEUP semester

SGPA------------------- CGPA------------------ Credit -------------------------- Cumulative Credit----------------------

(If student is appearing in makeup semester, please note the detail in separate sheet.)
 Semester-V
Swayam/MOOC course details -…………………………………………………………………….
Cours Mi Mi End term Practi Attendan Quiz/ Assignments Remark
e d d marks/ cal ce s
Register Se Se Grade Mark %
ed mI m II s/ T P I I I I V
Ma Mar grade I I V
rks ks I

SGPA------------------- CGPA------------------ Credit -------------------------- Cumulative Credit----------------------

Semester-VI
Swayam/MOOC course details -…………………………………………………………………….
Cours Mi Mi End term Practi Attendan Quiz/ Assignments Remark
e d d marks/ cal ce s
Register Se Se Grade Mark %
ed mI m II s/ T P I I I I V
Ma Mar grade I I V
rks ks I

Note- Use similar table if student opts MAKEUP semester

SGPA------------------- CGPA------------------ Credit -------------------------- Cumulative Credit----------------------

(If student is appearing in makeup semester, please note the detail in separate sheet.)
 Semester-VII
Swayam/MOOC course details -…………………………………………………………………….
Cours Mi Mi End term Practi Attendan Quiz/ Assignments Remark
e d d marks/ cal ce s
Register Se Se Grade Mark %
ed mI m II s/ T P I I I I V
Ma Mar grade I I V
rks ks I

SGPA------------------- CGPA------------------ Credit -------------------------- Cumulative Credit----------------------

Semester-VIII
Swayam/MOOC course details -…………………………………………………………………….
Cours Mi Mi End term Practi Attendan Quiz/ Assignments Remark
e d d marks/ cal ce s
Register Se Se Grade Mark %
ed mI m II s/ T P I I I I V
Ma Mar grade I I V
rks ks I

Note- Use similar table if student opts MAKEUP semester

SGPA------------------- CGPA------------------ Credit -------------------------- Cumulative Credit----------------------

(If student is appearing in makeup semester, please note the detail in separate sheet.)
 Mentoring Diary
1. Record of major absence
Sr. No. Peri Reas
od on
Fro T
m o

2. Involvement of the Student in disciplinary activities (if any)

Dat Activiti Punishment Remarks
es es
3. Record of Meetings with Mentor
Mentors will discuss on points like (but not limited to) Problem faced, skills, activities,
mannerism, career, Library Visit, regularities, Assignment, Quiz, Project, Book issue,
Reading outside syllabus, Personal looks, Seminar, Paper presentation, etc
Date of Tentative Advice Given by the Mentor Sign of Sign of
Meeting % the the
Attendance stude Ment
nt or
Date of Tentative Advice Given by the Mentor Sign Sign
Meeting % of of
Attendance the the
student Mentor