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Department of Technical Education , Skill Development and Employment
Madhya Pradesh Scholarship Portal 2.0
Renewal Application Mukhyamantri Medhavi Vidhyarthi Yojna Application form for year 2023-24
Applicant Unique ID: 4507214 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna
Application ID: 10611253
First Time Lock Date: 25/10/2024
Version No: 1 Verification Code: 4676 Lock Date: 25/10/2024 IPAddress : 157.34.50.4
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 : M.A.N.I.T. Bhopal Course : B.Tech/Mechenical Engineering/2nd Year [9604
District: BHOPAL
Details Application Form Name of Entrance Examination : JEE Main
Name SANJEEV DHAKAD Roll No of Entrance Examination : RJ08000523
Father Name SHIVRAJSINGHDHAKAD Common Rank in(JEE main/NEET/CLAT) : 46443
DOB 20/09/2004
Gender Male [पुरुष]
Category OBC [अ.पि.व.]
Religion : Hindu Special Category : No I O
2. Domicile of M.P. : Yes,Student is Domicile of Madhya Pradesh I O
3.Academic Details As Reported by Student : Enrollment No. : 2211601221 Admission Date :15/07/2023 I O
Previous Year Percentage : 70.04
Details As Reported by Student
Admission Mode Centralized Counselling
Institute [51005],M.A.N.I.T. Bhopal District: BHOPAL
Course B.Tech/Mechenical Engineering/2nd Year [9604]
Academic Year 2023-24
I O
Hostel Admission 15/07/2023
4. Total Annual Family Income : Rs.40000/-
Father/ Husband Occupation : Farmer / Agriculture, Income: 40000/-
Mother Occupation : House Wife ,Income: 0/- I O
Other Income : Rs.0/-
5. Contact Details Mobile No : 9522384250 SANJEEVDHAKAD9787[AT]GMAIL[DOT]COM I O
Correspondence Address : CHORAKHERI GUNA, District :- GUNA
Permanent Address : MANIT BHOPAL, District :- BHOPAL
6. Total Annual Fees Claimed(Rs.) 57000/- I O
Generated by MP Medhavi Portal as on 25/10/2024
Ȫ\]ȪȪ_èȡ¡ȰȪ]ǓȡȧèȡȢȨȣȯǔÈ¡ȡƭȡɅȲ[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 2023-24
Applicant Unique ID: 4507214 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna
Application ID: 10611253
First Time Lock Date: 25/10/2024
Version No: 1 Verification Code: 4676 Lock Date: 25/10/2024 IPAddress : 157.34.50.4
ȡȧȪȡDeclaration From Student and his Parent
]ȯfȲȡȧȪȡ
We, SANJEEV DHAKAD S/o SHIVRAJSINGHDHAKAD and SHIVRAJSINGHDHAKAD hereby declare that 12th Board Roll No, Board Name, Board
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.
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]ȡȲĤǓȪȢȣ¢ȡ\ǕĐȡȲɅ\ȲǗǓȡȢȡ[]ɇ\ȡ`Ȳȡ\ÛǗ[fȲ¡ȣ¡Ȱ@]ȯȯȪ[
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¡Ȱ@\`ȪƠȡȡȣȢȢèȡ_ȡȢ¡ȰȪȲǗ[ȡȡȣȡȯȢfȲ¡ȡȯȡȡǗȢȡ[ȡ¡ȣȯf
ȲȡȢȧ¢ȡèȲğ¡ɉȯ@
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ȣ_¡Ȱ`ȯȡȯȣȡȯȢ)^¡ȯĐȡȡȯǔÛȡȸȪ¡ȯȡȯfȢȢȪȡȯ\Û[Ȣ
ȢȡğǙƣȯǔ[ȢȡǑȡȡȯȡȡȡȸȪȡȣǗȢÞȰèɅȡǑȡȡȯȡȡȡğǙƣèȢǙȡ[
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Date (Signature of Parent / Father/ ȡȡȯ¡èȡ¢(Signature of Student / ]ȯȯ¡èȡ¢
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 Medhavi Portal as on 25/10/2024
