Medi-Caps University, Indore

PRE-ALUMNI INFORMATION/FEEDBACK FORM

Please fill up the details below mandatory fields are marked with *

Affix your
Enrollment No: ____________
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1. PERSONAL INFORMATION
Title (Mr/Mrs/Ms/Dr)

First Name Blood Group

Middle Name Gender (M/F)

Last Name Date of Birth _ _ /_ _ /_ _ _ _ (dd/mm/yy)

Email Mobile

Personal web page http://

2. ACADEMIC INFORMATION
Qualification 1 (Mention your qualifications at MU) [leave which is not applicable]
Batch Course Degree
Branch Specialization(PG only) Faculty(Ph.D only)
(paasing year) (UG/PG/Ph.D)

1.

2.

3. CONTACT INFORMATION
Residence Address

Address

Country State

City Pin Code

Phone(R) ______ (Country code) __________(City code) _____________________________ (Number)

4. APPEREANCE/QUALIFYING IN COMPETITIVE EXAMS [please provide details]

1. Have you passed in CAT? If yes then provide details, if no leave blank
Score
2. Have you passed in GATE/NET/SLAT? If yes then provide details, if no leave blank
Rank Discipline
 3. Have you passed in GMAT/GRE if yes then provide details if no leave blank
Score
4. Have you passed in TOFEL if yes then provide details if no leave blank
Score
5. Have you passed in any other competitive examination like UPSC/Sate PSC/ES/Bank/SSC etc, if yes
then provide details if no leave blank
Details
6. If you placed by the university, please specify company name
Company Name
7. Higher Studies if any, leave blank if not
Discipline University/Inst.

Medi-Caps University shall be thankful to and appreciate you, if you can spare some of your valuable time
to fill up this feedback form and give us your valuable suggestions for further improvement of the Institute.
Your valuable inputs will be of great use to improve the quality of our academic programs and enhance the
credibility of the University. Hence your feedback on Institute will help us to improve our approach in
Academics.
Dear Student,
Please give your overall assessment of our University academics. Please rate on following criterion :
1-Unsatisfactory, 2- Satisfactory, 3- Fair, 4- Good, 5- Very Good
Sr. Details 1 2 3 4 5
1 Admission Procedure
2 Fee structure
3 Environment
4 Infrastructure & Lab facilities
5 Faculty
6 Project Guidance
7 Quality of support material
8 Training & Placement
9 Library
10 Canteen Facilities
11 Hostel Facilities
12 Overall Rating of the University
13 Alumni Association/ Network of Old Friends

Please suggest any skills you want our University should focus on for grooming of students. All of your
suggestions are welcome.

Candidate Declaration
I hereby declare that all the information given by me is genuine. I will be responsible for any false information given here.

Authorized Signature Candidate Signature

Address: Medi-Caps University, Pigdambar, Rau, A.B. Road, Indore (M.P)