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MEDI-CAPS UNIVERSITY, INDORE
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
II
III
IV
VI
VII
VIII
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
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
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
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