Student Mentoring Form

1. Name of the Student (Block Letters):______________________________________ Photo

2. Name of the Parent/Gordian :_______________________________________

3. College Enrollment Number :_______________________________________

4. Date of Admission : DD MM YYYY

5. Name of the Branch : Department of Automobile Engineering
6. Percentage of marks secured in : X class XII Class
7. JEE/ GUJCET Rank :

GEN SC ST OBC
8. Category (Tick Mark) :

9. Category of Admission (Tick Mark) : ACPC Management/NRI

10. Permanent Address (with Pin code) Correspondence Address (with Pin code)

11. Date of Birth: DD MM YYYY

12. Gender : Male /Female
13. Student Mobile No. :__________________________ Parent Mobile No.___________________
14. Student e-mail : Parent e-mail :
15. Whether staying along with parents: Yes No Blood Group

16. If, No mention Hostel/Room Address:

17. Monitoring Attendance/ Academics of Student:
1st YEAR 1st SEMESTER

CIE SEM IU % of Attendance

Reg/Rem No. of Month No. of Name % of the
S.No Attempts -Year Attempts of the attendanc
Month e at the Action
end of the Taken/Suggestions
month given
Subject Name TH PR TH PR Grade
1
2
3
4
5
6
7
8
9
10
11
12

18. Details of Mentor Interaction with Student/Parent

S.No Date of Specific Problem Raised Suggestion / Solutions Signature of the
Interaction Given Student/Parent

19. Co-Curricular Activities

S.No Date Event particulars Achievement
20. Extra- Curricular Activities
S.No Date Event particulars Achievement

Signature of the Student Signature of the Mentor