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Medhavi Applicant Form

1. The document is an application form for the Mukhyamantri Medhavi Vidhyarthi Yojna scholarship scheme in Madhya Pradesh for the 2021-22 academic year. 2. The form contains details of the applicant such as name, father's name, date of birth, category, academic details, family income, contact details, correspondence address, and details of the institution including course and fees. 3. Both the applicant and parent declare that all information provided in the form is true and complete, and understand penalties if any information is found to be false. The form also contains signatures of institute officials certifying eligibility.

Uploaded by

Shivansh Mishra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
859 views

Medhavi Applicant Form

1. The document is an application form for the Mukhyamantri Medhavi Vidhyarthi Yojna scholarship scheme in Madhya Pradesh for the 2021-22 academic year. 2. The form contains details of the applicant such as name, father's name, date of birth, category, academic details, family income, contact details, correspondence address, and details of the institution including course and fees. 3. Both the applicant and parent declare that all information provided in the form is true and complete, and understand penalties if any information is found to be false. The form also contains signatures of institute officials certifying eligibility.

Uploaded by

Shivansh Mishra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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˜è™ȡ¡ȰȪ]”Ǔ“€Š˜žȡ €ȧ™蝞ȡ Ȣ”Ȩ›ȣŠȯǔȓ€˜¡ȡͪƭȡ›™˜Ʌ Ȳ”€[€š €ȯ¡Ȱ)

Department of Technical Education , Skill Development and Employment


Madhya Pradesh Scholarship Portal 2.0
Additional Claim Mukhyamantri Medhavi Vidhyarthi Yojna Application form for year
Application
2021-22

Applicant Unique ID: 4280925 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna


Application ID: 10424554
First Time Lock Date: 16/09/2022
Version No: 1 Verification Code: 9407 Lock Date: 16/09/2022 IPAddress : 122.168.67.61
Instructions for colleges & offices: Please check all information in each section and place a tick mark in on the box. Institute
will use the first Box with I sign and Sanctioning Office will use second box with O sign in it.
Institute : [53054],Faculty of Engineering and Technology(VIT Bhopal University, Course : B.Tech/Computer Science Engineering /2nd
Sehore) District: SEHORE Year [9602]

Details Application Form Name of Entrance Examination : JEE Main


Details Application Form Roll No of Entrance Examination : MP07101675
Details Application Form Common Rank in(JEE main/NEET/CLAT) : 82914
Details Application Form
Details Application Form
Details Application Form
Details Application Form
Details Application Form
Name SHIVANSH MISHRA

Father Name SHARADMISHRA


DOB 04/10/2002
Gender Male #”ǕǽŸ%
Category GENERAL # ȡ˜ȡۙ%

Religion : Hindu Special Category : No I O


Aadhar No. : XXXXXXXX6856

2. Domicile of M.P. : Yes,Student is Domicile of Madhya Pradesh I O

3.Academic Details As Reported by Student : Enrollment No. : 2020192035 Admission Date :12/07/2021 I O

Previous Year Percentage : 74.90

Details As Reported by Student


Details As Reported by Student
Details As Reported by Student
Details As Reported by Student
Details As Reported by Student I O
Details As Reported by Student
Details As Reported by Student
Details As Reported by Student
Admission Mode Direct Admission

Institute [53054],Faculty of Engineering and Technology(VIT Bhopal University, Sehore) District: SEHORE

Course B.Tech/Computer Science Engineering /2nd Year [9602]

Academic Year 2021-22

Hostel Admission Non-Hosteler(Day-Scholar)

4. Total Annual Family Income : Rs.423892/-


Father/ Husband Occupation : Private Service, Income: 423892/-
Mother Occupation : House Wife ,Income: 0/- I O
Other Income : Rs.0/-

5. Contact Details Mobile No : 7067525241 SHIVANSHMISHRA410[AT]GMAIL[DOT]COM I O

Generated by MP Scholarship Portal as on 30/09/2022


“ȪŠ\‚š]”€Ȫ€Ȫ_ ˜è™ȡ¡ȰȪ]”Ǔ“€Š˜žȡ €ȧ™蝞ȡ Ȣ”Ȩ›ȣŠȯǔȓ€˜¡ȡͪƭȡ›™˜Ʌ Ȳ”€[€š €ȯ¡Ȱ)

Department of Technical Education , Skill Development and Employment


Madhya Pradesh Scholarship Portal 2.0
Additional Claim Mukhyamantri Medhavi Vidhyarthi Yojna Application form for year
Application
2021-22

Applicant Unique ID: 4280925 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna


Application ID: 10424554
First Time Lock Date: 16/09/2022
Version No: 1 Verification Code: 9407 Lock Date: 16/09/2022 IPAddress : 122.168.67.61
Correspondence Address : 142 GANESH PURI COLONY
KHAJRANA, District :- INDORE
Permanent Address : 142 GANESH PURI COLONY
KHAJRANA, District :- INDORE

6. Total Annual Fees Claimed(Rs.) 50000/- I O

]ȯ‘€fȲ”ȡ›€€ȧƒȪŸŽȡDeclaration From Student and his Parent


We, SHIVANSH MISHRA S/o SHARADMISHRA and SHARADMISHRA hereby declare that 12th Board Roll No, Board Name, Board Year,
Aadhaar No, SAMAGRA ID, Entrance Exam Roll No, Rank, Marks, Domicile, Annual Income and occupation details of father and Mother,
Amount Claimed, Hostel Status, College detils, Course Details, Category and all other information given in the application form is complete and
correct. We have not submitted any other application for Mukhyamantri Medhavi Vidharthi Yojna or any other scheme that offer the reimbursement of
fee for current academic year in any other institution. We also undertake that, if any information given above is found to be false at any stage, entire
amount of scholarship will be recovered and Director, Technical Education , Government of Madhya Pradesh will be free to register FIR and initiate
legal penal action and against us.

¡˜SHIVANSH MISHRA S/o SHARADMISHRA kšSHARADMISHRA ƒȪŸŽȡ€šȯ¡ɇͩ€`”šȪƠ‡ȡ“€ȡšȣ ¡ȣ¡ȰfȲ€¢ȡCD–ȪŒ[


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 ¡ȣ¡Ȱ@]ȯ‘€“ȯ”ȪŠ[›”š^  ğ˜ȯ˜Ǖə˜ȲğȢ˜ȯ’ȡȢͪÚ™ȡȸ™Ȫ‡“ȡfȲ\ۙͩ€ Ȣ\ۙ™Ȫ‡“ȡ€ȯ\Ȳ‚[ͩ€ Ȣ\ۙ Ȳèȡ“˜Ʌ
]ȯ‘“ĤèǕ“¡ȣȲͩ€™ȡ¡Ȱ@\‚š`”šȪƠ‡ȡ“€ȡšȣͩ€ Ȣ—Ȣ菚”š‚›”ȡ_‡ȡȢ¡ȰȪ Ȳ”ǗŽ[šȡͧžȡͪ” ›ȣ‡ȡȯ‚ȢfȲ¡˜ȡšȯͨ›ȡ•
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™Ǒ‘¡˜‚›Ø™ɉ‡ȡ“€ȡšȣ€ȯ]’ȡš”š†ȡğǙǓ›ȯȯ¡Ǖ™ȯ”ȡf‚™ȯȪ¡˜ȡšȣ†ȡğǙͪƣǓ“šè€š‘ȣ‡ȡȯ‚Ȣȡ†ȡğǙͪƣ€ȧǔ‡“Ȣ
š€˜‘ȣ‚_¡Ȱ` ȯȡ” ›ȯ›ȣ‡ȡȯ‚Ȣ)^ š¡€ȯͩЙȡ€›ȡ” ȯ ˜ǔےͪ’ȡȸ€Ȫ¡˜ȯžȡ€ȯͧ›fͩ€ Ȣ—Ȣ™Ȫ‡“ȡ€ȯ\ۏ‚[ͩ€ Ȣ
—Ȣ†ȡğǙͪƣ ȯͪǔ‡[
ŒȢȡš €šǑ‘™ȡ‡ȡ™ȯ‚ȡȡͪ’ȡȸ€Ȫ€ȡ›ȣ Ǘ…Ȣ
ޛȰ€ͧ›èŠ ˜ɅŒȡ›Ǒ‘™ȡ‡ȡ™ȯ‚ȡȡ†ȡğǙͪƣèȢ€Ǚ€ȡ[
\ͬ’€ȡšȣ\ȡ\ۙ ¢˜\ͬ’€ȡšȣ]æ™€ ˜ˆȯ‚ɅȪ` €ȯͪǽڑ—ȡšȢ™‘ÖŒ ȲǑ¡ȡ€ȧ’ȡšȡjȲfȲ
€ȯ¡f•]_]š‘‡[€šȡ_‡ȡ€š É€ȡ™[ȡ¡ȣ€ȧ‡ȡȯ‚Ȣ)

Date (Signature of Parent / Father/ ”ȡ›€ͪ”ȡ€ȯ¡èȡ¢š (Signature of Student / ]ȯ‘€€ȯ¡èȡ¢š

Declaration from Institute Head & Institute Scholarship Nodal Officer


We, hereby, certify that the student is enrolled in the approved course of Govt MP. All the details filled by the student in the above application
form have been verified with the original documents and have been found to be correct and authentic. He/She is eligible for sanction of
scholarship. College has ORIGINAL COPY of his School Leaving Certificate. He is attending regular Classes, as per the instructions of Government
We have verified all details as per the scheme guidelines & instructions and recommend him for sanction of scholarship as per the rules. We also
undertake that, if the above student does not attend the classes regularly or discontinues the course, We will immediately report the matter to the
Director, Technical Education so that his scholarship can be put on hold. In case any information found to be incorrect, Government will be free to
initiate action against the institute.
The institute is accredited by the Government and permission is given to conduct related course.

Date (Signature ) (Signature ) (Signature )


MMVY Scheme Incharge HOD Director/Principal

Generated by MP Scholarship Portal as on 30/09/2022


“ȪŠ\‚š]”€Ȫ€Ȫ_ ˜è™ȡ¡ȰȪ]”Ǔ“€Š˜žȡ €ȧ™蝞ȡ Ȣ”Ȩ›ȣŠȯǔȓ€˜¡ȡͪƭȡ›™˜Ʌ Ȳ”€[€š €ȯ¡Ȱ)

Department of Technical Education , Skill Development and Employment


Madhya Pradesh Scholarship Portal 2.0
Additional Claim Mukhyamantri Medhavi Vidhyarthi Yojna Application form for year
Application
2021-22

Applicant Unique ID: 4280925 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna


Application ID: 10424554
First Time Lock Date: 16/09/2022
Version No: 1 Verification Code: 9407 Lock Date: 16/09/2022 IPAddress : 122.168.67.61

Last Exam Marksheet

Fees Receipt

Generated by MP Scholarship Portal as on 30/09/2022


“ȪŠ\‚š]”€Ȫ€Ȫ_ ˜è™ȡ¡ȰȪ]”Ǔ“€Š˜žȡ €ȧ™蝞ȡ Ȣ”Ȩ›ȣŠȯǔȓ€˜¡ȡͪƭȡ›™˜Ʌ Ȳ”€[€š €ȯ¡Ȱ)

Department of Technical Education , Skill Development and Employment


Madhya Pradesh Scholarship Portal 2.0
Additional Claim Mukhyamantri Medhavi Vidhyarthi Yojna Application form for year
Application
2021-22

Applicant Unique ID: 4280925 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna


Application ID: 10424554
First Time Lock Date: 16/09/2022
Version No: 1 Verification Code: 9407 Lock Date: 16/09/2022 IPAddress : 122.168.67.61

Admission Slip

Generated by MP Scholarship Portal as on 30/09/2022

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