DESH BHAGAT UNIVERSITY, MANDI GOBINDGARH
FACULTY: ______________
DEPARTMENT:
PASTE
PHOTO
HERE
MENTEE RECORD CARD
For Office Use Only
Name of the Mentor :……………………………
Designation::……………………………………… Department: …………………………………………
PERSONAL INFORMATION
1. Name of the Mentee: …………………………… Roll No:………………….
2. Programme/ Semester: ……………………………Batch:……………………
3. ABC ID:……………………………………………………………………….
Permanent Present
Address………………………………………… Address:……………………………..……………..
………………………………………………………. …………………………………………..…………..
………………………………………………………. ……………………………………………..………..
Distt…………..………State ……….…………... Distt……………………State………..………..
Pin Code: Pin Code:
Phone Mobile Fax / E-mail Phone Mobile Fax / E-mail
4. Father/Mother/Guardian’s Name and address (if any):
Phone Mobile Fax / Email
EDUCATIONAL DETAILS
5. Education:
Examinations Board / Ye Division CGPA/Marks(%) Remarks
Univer ar
sity
High School
Inter / 10+2
BA/BSc/B.Tec h/
________
Others
(Specify)
6. Details of the family members*:
S. Name Relationship Age Qualifications/ Occupation
No. (Years)
(a)
(b)
(c)
(d)
(e)
*(Some students may feel uncomfortable but the details can be included)
7. Special Achievements: ………………………………………………………………………..
……..……………………………………………………………………………………………
8. Area of interest where his/her talent can be utilized at DBU:
…………………..………….……………………………………………………………………
………………………..………………………………………………………………………….
9. Additional Information: ………………………………………………………………………..
………………………………………………………………………………………………………
Dated: ………..… (Signatures of the Mentee)
IN CASE OF EMERGENCY
Person to be contacted
(a) ………………… …………………….. ……………………………(Local)
(b) ………………… ……………………. …………………………… (Outstation)
Dated: ………..… (Signatures of the Mentor)
Verified by : HOD
Approved by : Director / Principal
RECORD OF MENTOR/MENTEE MEETINGS
(MAINTAINED BY MENTOR/TEACHER/FACULTY)
S. Date Discussion points Follow up action Initials of Initials
No. the Mentee of
the
Mento
r
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
…………………………………..
Verification by HoS (Semester End)
Signature:………………………
Name:……………………………
UID:………………..……………
Date:……………………………..
