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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
Renewal Application Mukhyamantri Medhavi Vidhyarthi Yojna Application form for year 2022-23

Applicant Unique ID: 3940084 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna

Application ID: 10482731
First Time Lock Date: N.A
Version No: N.A Verification Code: N.A Lock Date: N.A IPAddress : N.A
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 : [59005],Indian Institute of Technology Delhi District: New Delhi Course : B.Tech/Electrical Engineering (Power and
Automation)/3rd Year [9645]

Details Application Form Name of Entrance Examination : JEE Main

Name SATYAM SINGH GOUR Roll No of Entrance Examination : MP06301582
Father Name RAMSEVAK SINGH GOUR Common Rank in(JEE main/NEET/CLAT) : 2302
DOB 19/10/2002
Gender Male #”ǕǽŸ%
Category GENERAL # ȡ˜ȡۙ%

Religion : Hindu Special Category : No I O

Aadhar No. : XXXXXXXX9257

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

3.Academic Details As Reported by Student : Enrollment No. : 2020EE30625 Admission Date :02/08/2022 I O

Previous Year Percentage : 58.12

Details As Reported by Student

Admission Mode Centralized Counselling

Institute [59005],Indian Institute of Technology Delhi District: New Delhi

Course B.Tech/Electrical Engineering (Power and Automation)/3rd Year [9645]

Academic Year 2022-23

I O
Hostel Admission 16/11/2020

4. Total Annual Family Income : Rs.398750/-

Father/ Husband Occupation : State Govt., Income: 398750/-
Mother Occupation : House Wife ,Income: 0/- I O
Other Income : Rs.0/-

5. Contact Details Mobile No : 9926539490 SVVNBHIND[AT]GMAIL[DOT]COM I O

Correspondence Address : VIVEKANAND SCHOOL HEWATPURA ROAD GANDHI NAGAR, District :- BHIND

Permanent Address : VIVEKANAND SCHOOL HEWATPURA ROAD GANDHI NAGAR, District :- BHIND

6. Total Annual Fees Claimed(Rs.) 224800/- I O

Generated by MP Scholarship Portal as on 19/01/2023

 “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
Renewal Application Mukhyamantri Medhavi Vidhyarthi Yojna Application form for year 2022-23

Applicant Unique ID: 3940084 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna

Application ID: 10482731
First Time Lock Date: N.A
Version No: N.A Verification Code: N.A Lock Date: N.A IPAddress : N.A
]ȯ‘€fȲ”ȡ›€€ȧƒȪŸŽȡDeclaration From Student and his Parent
We, SATYAM SINGH GOUR S/o RAMSEVAK SINGH GOUR and RAMSEVAK SINGH GOUR 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.

¡˜SATYAM SINGH GOUR S/o RAMSEVAK SINGH GOUR kšRAMSEVAK SINGH GOUR ƒȪŸŽȡ€šȯ¡ɇ
ͩ€`”šȪƠ‡ȡ“€ȡšȣ ¡ȣ¡ȰfȲ€¢ȡCD–ȪŒ[”šȣ¢ȡ€ȡ\“ǕИȡȲ€]’ȡš“Ȳ–šĤǓ™Ȫ‚Ȣ”šȣ¢ȡ\“ǕИȡȲ€šɅ€\Ȳ€˜Ǘ›Ǔ“ȡ ȢȡͪŸ[€
]™–ɇ€\€ȡ`ȲŠȡ\ۙͪšŽ”ǗŽ[fȲ ¡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•€ȡ“Ǘ“Ȣ€ȡ™[ȡ¡ȣ€ȯͧ›f Ȳ…ȡ›€€“Ȣ€ȧͧž¢ȡ蝏Ȳğ¡ɉ‚ȯ@

™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 19/01/2023

 “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
Renewal Application Mukhyamantri Medhavi Vidhyarthi Yojna Application form for year 2022-23

Applicant Unique ID: 3940084 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna

Application ID: 10482731
First Time Lock Date: N.A
Version No: N.A Verification Code: N.A Lock Date: N.A IPAddress : N.A

Last Exam Marksheet

Fees Receipt

Generated by MP Scholarship Portal as on 19/01/2023

 “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
Renewal Application Mukhyamantri Medhavi Vidhyarthi Yojna Application form for year 2022-23

Applicant Unique ID: 3940084 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna

Application ID: 10482731
First Time Lock Date: N.A
Version No: N.A Verification Code: N.A Lock Date: N.A IPAddress : N.A

Admission Slip

Generated by MP Scholarship Portal as on 19/01/2023