Department of Technical Education, Skill Development and Employment

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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 2021-22
Applicant Unique ID: 3488262 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna

Application ID: 10408410
First Time Lock Date: 17/02/2022
Version No: 1 Verification Code: 4899 Lock Date: 17/02/2022 IPAddress : 106.66.20.227
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 : [59083],Rajiv Gandhi National University of Law District: Patiala Course : B.A.LL.B(Hons.)(NLIU)/B.A.LL.B (Hons.)/3rd
Year [5501]
Details Application Form Name of Entrance Examination : CLAT

Name MANISH CHAURASIYA Roll No of Entrance Examination : 119017199
Father Name ASHOKKUMARCHAURASIYA Common Rank in(JEE main/NEET/CLAT) : 10020
DOB 08/06/2001
Gender Male #Ǖǽ%
Category SC #\Ǖ ǗͬȡǓ%
Religion : Hindu Special Category : No I O

Aadhar No. : XXXXXXXX2543
2. Domicile of M.P. : Yes,Student is Domicile of Madhya Pradesh I O
3.Academic Details As Reported by Student : Enrollment No. : 19111 Admission Date :02/07/2019 I O
Previous Year Percentage : 69.66
Details As Reported by Student

Admission Mode Centralized Counselling
Institute [59083],Rajiv Gandhi National University of Law District: Patiala
Course B.A.LL.B(Hons.)(NLIU)/B.A.LL.B (Hons.)/3rd Year [5501]
Academic Year 2021-22

I O
Hostel Admission 02/07/2019
4. Total Annual Family Income : Rs.96000/-

Father/ Husband Occupation : Own Business/Shop, Income: 96000/-
Mother Occupation : House Wife ,Income: 0/- I O
Other Income : Rs.0/-
5. Contact Details Mobile No : 8269234701 CHAURASIYAM700[AT]GMAIL[DOT]COM I O

Correspondence Address : SHITLA COLONY HARIRAM KI KUIYA MALANPUR GOHAD, District :- BHIND
Permanent Address : GRAM/POST KATROLTEH. MEHGAON, District :- BHIND
6. Total Annual Fees Claimed(Rs.) 171628/- I O
Generated by MP Scholarship Portal as on 18/04/2023

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]ȯfȲȡȧȪȡDeclaration From Student and his Parent
We, MANISH CHAURASIYA S/o ASHOKKUMARCHAURASIYA and ASHOKKUMARCHAURASIYA 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.
¡MANISH CHAURASIYA S/o ASHOKKUMARCHAURASIYA kASHOKKUMARCHAURASIYA Ȫȡȯ¡ɇ

ͩ`ȪƠȡȡȣ ¡ȣ¡ȰfȲ¢ȡCDȪ[ȣ¢ȡȡ\ǕĐȡȲ]ȡȲĤǓȪȢȣ¢ȡ\ǕĐȡȲɅ\ȲǗǓȡ Ȣȡͪ[
]ɇ\ȡ`Ȳȡ\ÛͪǗ[fȲ ¡ȣ¡Ȱ@]ȯȯȪ[^ ğȯǕÉȲğȢȯȡȢͪÚȡȸȪȡfȲ\Ûͩ Ȣ
\ÛȪȡȯ\Ȳ[ͩ Ȣ\Û ȲèȡɅ]ȯĤèǕ¡ȣȲͩȡ¡Ȱ@\`ȪƠȡȡȣͩ ȢȢèȡ_ȡȢ¡Ȱ
Ȫ ȲǗ[ȡͧȡͪ ȣȡȯȢfȲ¡ȡȯͨȡȡǗȢȡ[ȡ¡ȣȯͧf ȲȡȢȧͧ¢ȡèȲğ¡ɉȯ@
Ǒ¡Øɉȡȡȣȯ]ȡȡğǙǓȯȯ¡ǕȯȡfȯȪ¡ȡȣȡğǙͪƣǓèȣȡȯȢȡȡğǙͪƣȧǔȢ
ȣ_¡Ȱ` ȯȡ ȯȣȡȯȢ)^ ¡ȯͩĐȡȡ ȯ ǔÛͪȡȸȪ¡ȯȡȯͧfͩ ȢȢȪȡȯ\Û[ͩ Ȣ
ȢȡğǙͪƣ ȯͪǔ[
ȢȡǑȡȡȯȡȡͪȡȸȪȡȣ ǗȢ
ÞȰͧèɅȡǑȡȡȯȡȡȡğǙͪƣèȢǙȡ[
\ͬȡȣ\ȡ\Û ¢\ͬȡȣ]æ ȯɅȪ` ȯͪǽÚȡȢÖ ȲǑ¡ȡȧȡȡjȲfȲ
ȯ¡f]_][ȡ_ȡ Éȡ[ȡ¡ȣȧȡȯȢ)
Date (Signature of Parent / Father/ ȡͪȡȯ¡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



Last Exam Marksheet
Fees Receipt



Admission Slip

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Department of Technical Education , Skill Development and Employment

Applicant Unique ID: 3488262 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna

Details Application Form Name of Entrance Examination : CLAT

Religion : Hindu Special Category : No I O

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

Previous Year Percentage : 69.66

Details As Reported by Student

Institute [59083],Rajiv Gandhi National University of Law District: Patiala

Course B.A.LL.B(Hons.)(NLIU)/B.A.LL.B (Hons.)/3rd Year [5501]

Academic Year 2021-22

4. Total Annual Family Income : Rs.96000/-

5. Contact Details Mobile No : 8269234701 CHAURASIYAM700[AT]GMAIL[DOT]COM I O

Permanent Address : GRAM/POST KATROLTEH. MEHGAON, District :- BHIND

6. Total Annual Fees Claimed(Rs.) 171628/- I O

Generated by MP Scholarship Portal as on 18/04/2023

Department of Technical Education , Skill Development and Employment

Applicant Unique ID: 3488262 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna

¡MANISH CHAURASIYA S/o ASHOKKUMARCHAURASIYA kASHOKKUMARCHAURASIYA Ȫȡȯ¡ɇ

Date (Signature of Parent / Father/ ȡͪȡȯ¡èȡ¢ (Signature of Student / ]ȯȯ¡èȡ¢

Declaration from Institute Head & Institute Scholarship Nodal Officer

Date (Signature ) (Signature ) (Signature )

Generated by MP Scholarship Portal as on 18/04/2023

Department of Technical Education , Skill Development and Employment

Applicant Unique ID: 3488262 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna

Last Exam Marksheet

Generated by MP Scholarship Portal as on 18/04/2023

Department of Technical Education , Skill Development and Employment

Applicant Unique ID: 3488262 Scheme : Mukhyamantri Medhavi Vidhyarthi Yojna

Generated by MP Scholarship Portal as on 18/04/2023

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¡MANISH CHAURASIYA S/o ASHOKKUMARCHAURASIYA kASHOKKUMARCHAURASIYA Ȫȡȯ¡ɇ

Date (Signature of Parent / Father/ ȡͪȡȯ¡èȡ¢(Signature of Student / ]ȯȯ¡èȡ¢