Student Mentoring / Counseling Folder

Academic Session _____________________

Name of Mentor : _________________________

Faculty : _________________________
Department : _________________________
Branch : _________________________
Section : _________________________
Student Group : _________________________
List of Students in the Group ……………….

No. Class and Batch Enrollment No. Name of Student Remark

10

11

12

13

14

15

16

17

18

19

20
 MEDI-CAPS UNIVERSITY, INDORE

Faculty & Department ………………….…………………..…….

General Details
1. Name : …………………………………………………………………………………….…….
2. Branch : ………………………… Enrollment No. : ………………………………………
3. DOB : ………………………… Nationality : ……………… Blood Group : ………
4. Adhar No. : …………………………
5. Present Address
…………………………………………………………………………….......……………………
…………………………………………………………………………….......……………………
Tel No………………………….Mob No……………………E-Mail………………………..……
6. Permanent Address
…………………………………………………………………………….......……………………
7. Father’s/Guardian’s Names ……………………………………… Occupation …………………
Tel No………………………….Mob No……………………E-Mail……………………..………
8. Mother’s/Guardian’s Names ……………………………………… Occupation …………………
Tel No………………………….Mob No……………………E-Mail……………………..………
9. Yearly income of Parent/Guardian…………………………………
10. Details of Brother, Sisters and their Profession
1. …………………………………………………………………………….......……………
2. …………………………………………………………………………….......……………
3. …………………………………………………………………………….......……………
4. …………………………………………………………………………….......……………
11. Present address of parent/guardian
…………………………………………………………………………….......……………………
Tel No………………………….Mob No……………………E-Mail……………………………
12. Health Problem, if any
…………………………………………………………………………….......……………………
…………………………………………………………………………….......……………………
13. Hobbies/Interests/Extra or Co-curricular activities
…………………………………………………………………………….......……………………
…………………………………………………………………………….......……………………
14. Achievements (up to12thclass)
…………………………………………………………………………….......……………………
…………………………………………………………………………….......……………………
15. Student Vision
…………………………………………………………………………….......……………………
…………………………………………………………………………….......……………………
16. Student Mission
…………………………………………………………………………….......……………………
…………………………………………………………………………….......……………………
17. Anti ragging affidavit filled- Yes/No …………………
18. NAD registration- Yes/No …………………
19. NDL and Digilocker registration- Yes/No …………………
20. Swayam/MOOC registration Yes/No …………………
21. Connected to Medi-Caps through
Facebook Yes/No …… Twitter Yes/No …… LinkedIn Yes/No …… Instagram Yes/No ……
YouTube Yes/No …… AccSoft Yes/No …… I-Cloud Yes/No ……
22. If Bus user, Bus No. ………………… If hosteller, Room No. ……………………….
 Academic Details
1. Examinations Cleared

Exam. Branch Board/University Passing Division % marks/

Year CGPA
10th
12th /Diploma
Bachelor’s
Degree
Master’s
Degree
Admission through (JEE/Qualifying Exam) …………………………………………
2. Co-curricular and extracurricular activities details including special achievements, if any
Semester Details

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-…………………………………………………………………….
Course Mid Mid End term Practical Attendance Quiz/ Assignments Remarks
Registered Sem I Sem II marks/ Marks/ %
Marks Marks Grade grade T P I II III IV V

Semester-II
Swayam/MOOC course details -…………………………………………………………………….
Course Mid Mid End term Practical Attendance Quiz/ Assignments Remarks
Registered Sem I Sem II marks/ Marks/ %
Marks Marks Grade grade T P I II III IV V

Note- Use similar table if student opts MAKEUP semester

Semester-III
Swayam/MOOC course details -…………………………………………………………………….
Course Mid Mid End term Practical Attendance Quiz/ Assignments Remarks
Registered Sem I Sem II marks/ Marks/ %
Marks Marks Grade grade T P I II III IV V

Semester-IV
Swayam/MOOC course details -…………………………………………………………………….
Course Mid Mid End term Practical Attendance Quiz/ Assignments Remarks
Registered Sem I Sem II marks/ Marks/ %
Marks Marks Grade grade T P I II III IV V

Note- Use similar table if student opts MAKEUP semester

Semester-V
Swayam/MOOC course details -…………………………………………………………………….
Course Mid Mid End term Practical Attendance Quiz/ Assignments Remarks
Registered Sem I Sem II marks/ Marks/ %
Marks Marks Grade grade T P I II III IV V

Semester-VI
Swayam/MOOC course details -…………………………………………………………………….
Course Mid Mid End term Practical Attendance Quiz/ Assignments Remarks
Registered Sem I Sem II marks/ Marks/ %
Marks Marks Grade grade T P I II III IV V

Note- Use similar table if student opts MAKEUP semester

Semester-VII
Swayam/MOOC course details -…………………………………………………………………….
Course Mid Mid End term Practical Attendance Quiz/ Assignments Remarks
Registered Sem I Sem II marks/ Marks/ %
Marks Marks Grade grade T P I II III IV V

Semester-VIII
Swayam/MOOC course details -…………………………………………………………………….
Course Mid Mid End term Practical Attendance Quiz/ Assignments Remarks
Registered Sem I Sem II marks/ Marks/ %
Marks Marks Grade grade T P I II III IV V

Note- Use similar table if student opts MAKEUP semester

 Mentoring Diary
1. Record of major absence
Sr. No. Period Reason
From To

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

Dates Activities Punishment Remarks
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 Attendance the the
student Mentor
Date of Tentative % Advice Given by the Mentor Sign of Sign of
Meeting Attendance the the
student Mentor