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नोट : अगर आपको कोई समस्‍या है तो आप निकटतम शासकीय/स्‍वशासी पॉलीटेक्निक महाविद्यालय में संपर्क कर सकते है ।

Department of Technical Education , Skill Development and Employment

Medhavi Kalyan Portal
Renewal Application Mukhyamantri Medhavi Vidhyarthi Yojna Application form for year 2024-25
Applicant Unique ID : 4510509
Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna
Application ID : 10630903
First Time Lock Date : 07/02/2025
Version No : 1 Verification code : 8241 Lock Date : 07/02/2025 IP Address : 103.185.242.129

Institute : Govt Adarsh Science College Rewa Course : > B. C. A./BCA/3rd Year [1030]
Details Application Form Name of Entrance Examination : --
Name ARVIND SINGH Roll No of Entrance Examination :
Father Name RAMESH Common Rank in (JEE main/NEET/CLAT) :
Date of Birth 13/05/2003 Religion : Hindu
Gender Male [पुरुष] Special Category : No
Category GENERAL [सामान्य]

2. Samagra Details :
Samagra Id: 188823585 Name: Arvind Singh
Father's Name: Ramesh Singh Mother's Name: Sunita Singh
Gender: Male DOB: 13/05/2003

3. Domicile of M.P. : Yes,Student is Domicile of Madhya Pradesh

4. Academic Details As Reported by Student :

Enrollment No. : 222030590031 Admission Date : 23/08/2024 Previous Year Percentage : 72.50
Details As Reported by Student
Admission Mode Centralized Counselling
Institute Govt Adarsh Science College Rewa
Course B. C. A./BCA/3rd Year [1030]
Academic Year 2024-25
Hostel Admission Non-Hosteler(Day-Scholar)

5. Total Annual Family Income : Rs. 75000/-

Father/Husband Occupation : Farmer / Agriculture, Income : 75000/-
Mother Occupation : House Wife, Income : 0/-
Other Income : Rs. 0/-

6. Contact Details Mobile No : 9516898345 ARVIND[DOT]REWA[DOT][AT]GMAIL[DOT]COM

Correspondence Address : KOTHI WARD, District :- REWA
Permanent Address : KOTHI WARD, District :- REWA
7. Total Annual Fees Claimed(Rs.) 21204/-

Generated by MP Scholarship Portal as on 07/02/2025

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2/7/25, 11:25 AM medhavikalyan.mp.gov.in/MedhaviChhatra/Pages/PrintApplication/PrintApplicationHTML.aspx?AppId=MTA2MzA5MDM=

नोट : अगर आपको कोई समस्‍या है तो आप निकटतम शासकीय/स्‍वशासी पॉलीटेक्निक महाविद्यालय में संपर्क कर सकते है ।

Department of Technical Education , Skill Development and Employment

Medhavi Kalyan Portal
Renewal Application Mukhyamantri Medhavi Vidhyarthi Yojna Application form for year 2024-25
Applicant Unique ID : 4510509
Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna
Application ID : 10630903
First Time Lock Date : 07/02/2025

Version No : 1 Verification code : 8241 Lock Date : 07/02/2025 IP Address : 103.185.242.129

आवेदक एवं पालक की घोषणा Declaration From Student and his Parent
We, ARVIND SINGH S/O RAMESH and RAMESH 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 details, 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 offers the reimbursement of fee for the current academic year in any other institution. We also undertake that, if any information given above
is found to be false at any stage, the entire amount of scholarship will be recovered and the Director, Technical Education, Government of Madhya Pradesh will be free
to register FIR and initiate legal penal action against us.

हम ARVIND SINGH S/O RAMESH और RAMESH घोषणा करते हैं कि उपरोक्त जानकारी सही है एवं कक्षा 12 बोर्ड परीक्षा का अनुक्रमांक, आधार नंबर, प्रतियोगी परीक्षा अनुक्रमांक, रँक,
अंक, मूल निवासी, वार्षिक आय बैंक अकाउं ट तथा अन्य विवरण पूर्ण एवं सही है। आवेदक ने पोर्टल पर इस सत्र में मुख्यमंत्री मेधावी विध्यार्थी योजना एवं अन्य किसी अन्य योजना के अंतर्गत
किसी अन्य संस्थान में आवेदन प्रस्तुत नहीं किया है । अगर उपरोक्त जानकारी किसी भी स्तर पर गलत पाई जाती है तो संपूर्ण राशि वापिस ली जावेगी एवं हमारे खिलाफ कानूनी कार्यवाही के
लिए संचालक, तकनीकी शिक्षा स्वतंत्र होंगे ।

यदि हम गलत तथ्यों, जानकारी के आधार पर छात्रवृति लेते हुये पाए गये तो हमारी छात्रवृत्ति निरस्त कर दी जावेगी तथा छात्रवृत्ति की जितनी रकम दी गई है उसे वापस ले ली जावेगी| इस
तरह के क्रियाकलाप से समन्धित विद्यार्थी को हमेशा के लिए किसी भी योजना के अन्तर्गत, किसी भी छात्रवृत्ति से विवर्जित (डीवार) कर दिया जायेगा तथा विधार्थी को काली सूची (ब्लैक
लिस्ट) में डाल दिया जायेगा तथा छात्रवृत्ति स्वीकृ तकर्ता अधिकारी अथवा अन्य सक्षम अधिकारी आवश्यक समझेगें तो उसके विरुध्द भारतीय दण्ड संहिता की धाराओं 177, 197, 198, 199, 200
एवं 420 के तहत एफ.आई.आर. दर्ज करवाई जाकर सख्त कार्यवाही की जावेगी |

Date (Signature of Parent / Father / पालक / पिता के हस्ताक्षर ) ( Signature of Student / आवेदक के हस्ताक्षर )

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 Dean/Director/Principal

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