Manipal University Jaipur CHAIRPERSON'S GOLD MEDAL FOR OVERALL EXCELLENCE Application Form Name of student: Registration Number: Programme: CGPA till date: Fillin the last column and attach documentary evidence of all your claims [S. [Activiy/teading scare [Remarks | Score ee «| details —___ [ebtaings | {tay [Academic Performance a GPAs - _ (i) Technical ae i _ (2) Journal Publications (International/National) an) (6) Conference Publications/mode! making 2h (c) Award in national/regional/University event aR | (4) Organization of Technical Club/Society event 2 | (e} Participation in technical Club/Society event Minimum | Til) | Sports Activities ~ T bila (a) Award in national/state Event ea een (b) Award in Regional/University Event apa THREE: cn | {c) Organization of Sports event 2 ee ta} Panipat in era eam sige ee (¢]_ Participation in University team event 1 | | {iv) | Cultural Activities a | (a) Award in national/state Event 3 _ || Maxinery (b) Award in Regional/University Event 2A etal (c) Organization of Cultural/Club event 2 ah | (dd Participation in University event-solo, 2 may |e) Participation in University team event a ae (a [seciatactiviies | | (a) Award/recognition at International /National level i | {b)_Award/recognition at Regional/University level an | {€) Coordination of Rotary/illage/biood 2 donation/cleanliness/teaching, etc., events (4) Participation in above events 1 {c)_Partiipation/volunteer in University event 1 (ui) | Leadership and Entrepreneurship (a) President/ Secretary of Student Counc an ||) Class Representative i | {o)_ Entrepreneurship activities 2 | (d) Coordinator Hostel/Mess committees or events 2 Le) Partcipation/tdember in Hostel/Mess committees |__| Jo be sent thequeh th Head of Department signaiure of Hod with seal Total obtained Signaturejof student