JIS UNIVERSITY

81 Nilgunj Road, Agarpara, Kolkata - 700109

MENTORSHIP FORM
INFORMATION OF THE MENTOR
NAME:

EMAIL ID :
CONTACT DETAILS:

PERSONAL DATA SHEET OF THE STUDENT

NAME: Ashutosh Prasad Yadav
FATHER’S NAME: Ramdeo Prasad Yadav
FATHER’S CONTACT NO: 9830239863
MOTHER’S NAME: Sunayana Yadav
MOTHER’S CONTACT NO: NA
NAME OF THE LOCAL
GUARDIAN (IF ANY):
LOCAL GURDIAN’S
CONTACT NO:
DEPARTMENT: BTECH - COMPUTER SCIENCE AND ENGINEERING
REGISTRATION NO: 191112015010 of 2019-20
ROLL NO: 191112015010
SECTION:
SEMESTER 1ST / 2ND / 3RD/ 4TH√ / 5TH/ 6TH / 7TH / 8TH (Put √)
YEAR OF ADMISSION: 2019
PERMANENT ADDRESS: 49/21 Sen Plaza 2 (3rd floor), Rabindra sarani, Rishra,
Hooghly, West Bengal.
CORRESPONDANCE 49/21 Sen Plaza 2 (3rd floor), Rabindra sarani, Rishra,
ADDRESS: Hooghly, West Bengal.
STUDENT’S MOBILE NO: 9836379071
EMAIL ID: ashutoshprasadyadav007@gmail.com
DATE OF BIRTH: 20/05/1996
BLOOD GROUP: O+
ADHAR NO: 493001377829
PAN NO (IF ANY): ANEPY9140J
VOTER ID NO (IF ANY): ANS2085041
CATEGORY: SC/ST/OBC/PH/GEN√ (Put √)
FAMILY INCOME: APPROX 4.5 LAKHS PER ANNUM
STATUS OF STUDENTSHIP: FULL /HALF FREE/GENERAL√ (Put √)
ADMISSION RANK:

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SIGNATURE OF THE STUDENT

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SIGNATURE OF THE MENTOR SIGNATURE OF THE HOD
 JIS UNIVERSITY
81 Nilgunj Road, Agarpara, Kolkata - 700109
MENTORSHIP FORM
WBJEE: JELET:

AIEEE: ANY OTHER: AMPAI

EDUCATIONAL QUALIFICATION:
TYPE OF SCHOOL / % OF MARKS YEAR OF MEDIUM OF
EXAM. COLLEGE NAME PASSING INSTRUCTION
10TH Stepping Stone School 60.00 2014 English
High
STANDARD

12TH Private Candidate 53.50 2019 English

STANDARD

GRADUATION JISU 1st sem-7.21 2023 English

2nd sem- 6.92
DIPLOMA
ANY OTHER

HOBBIES: Image Processing

SCHOLARSHIP
(IF ANY):

DUES CLEARED (PUT √):

1st Sem√ 2nd Sem√ 3rd Sem√ 4th Sem√ 5th Sem 6th Sem 7th Sem 8th Sem
ANY DISCIPLINARY ACTION TAKEN:

PLACEMENT STATUS:
PLACED IN

GATE/CAT/MAT/JEMAT EXAM:

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SIGNATURE OF THE STUDENT

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SIGNATURE OF THE MENTOR SIGNATURE OF THE HOD
 JIS UNIVERSITY
81 Nilgunj Road, Agarpara, Kolkata - 700109
MENTORSHIP FORM
ACADEMIC AND ATTENDANCE RECORDS
SEMESTER I:
SUBJECTS ATTENDANCE IN % CLASS TEST ASSIGN SEM. SGPA
CODE RESULT MARK
TH PR TOT I II BEST
EC101 21.00
HU101 16.00
M101 20.00
PH101 15.00
BSD 181 09.00
BSD 182 09.00 7.21
EC191 13.50
MC181 0.00
ME192 13.50
PH151 05.00
PH191 13.50
EC151 05.00

SEMESTER II:
SUBJECTS ATTENDANCE IN % CLASS TEST ASSIGN SEM. SGPA
CODE RESULT MARK
TH PR TOT I II BEST
CH201 18.00
CS201 30.00
EE201 21.00
M201 0.00
ME201 21.00
BSD 281 10.00
BSD 282 09.00
CH291 13.50 6.92
CS291 15.00
EE291 15.00
HU291 07.00
MC281 00.00
ME291 10.50
PR291 05.00
PR292 05.00

YGPA: 7.06

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SIGNATURE OF THE STUDENT

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SIGNATURE OF THE MENTOR SIGNATURE OF THE HOD
 JIS UNIVERSITY
81 Nilgunj Road, Agarpara, Kolkata - 700109
MENTORSHIP FORM

SEMESTER III:

SUBJECTS ATTENDANCE IN % CLASS TEST ASSIGN SEM. SGPA

CODE RESULT MARK
TH PR TOT I II BEST

SEMESTER IV:

SUBJECTS ATTENDANCE IN % CLASS TEST ASSIGN SEM. SGPA

CODE RESULT MARK

YGPA:

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SIGNATURE OF THE STUDENT

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SIGNATURE OF THE MENTOR SIGNATURE OF THE HOD
 JIS UNIVERSITY
81 Nilgunj Road, Agarpara, Kolkata - 700109
MENTORSHIP FORM

SEMESTER V:
SUBJECTS ATTENDANCE IN % CLASS TEST ASSIGN SEM. SGPA
CODE RESULT MARK
TH PR TOT I II BEST

SEMESTER VI:

SUBJECTS ATTENDANCE IN % CLASS TEST ASSIGN SEM. SGPA

CODE RESULT MARK
TH PR TOT I II BEST

YGPA:

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SIGNATURE OF THE STUDENT

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SIGNATURE OF THE MENTOR SIGNATURE OF THE HOD
 JIS UNIVERSITY
81 Nilgunj Road, Agarpara, Kolkata - 700109
MENTORSHIP FORM

SEMESTER VII:

SUBJECTS ATTENDANCE IN % CLASS TEST ASSIGN SEM. SGPA

CODE RESULT MARK
TH PR TOT I II BEST

SEMESTER VIII:

SUBJECTS ATTENDANCE IN % CLASS TEST ASSIGN SEM. SGPA

CODE RESULT MARK
TH PR TOT I II BEST

YGPA: FINAL DGPA:

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SIGNATURE OF THE STUDENT

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SIGNATURE OF THE MENTOR SIGNATURE OF THE HOD
 JIS UNIVERSITY
81 Nilgunj Road, Agarpara, Kolkata - 700109
MENTORSHIP FORM

SEMINAR / WORKSHOP / SOFT SKILL CLASS/ APTITUTE CLASS/ MOCK

INTERVIEW ATTENDED:
SL NO SEMINAR / WORKSHOP / SOFT DATE ORGANISED BY
SKILL CLASS/ APTITUTE
CLASS/ MOCK INTERVIEW
1 Webinar on “Learn to Design your 4th July, 2020 Energy Swaraj
own Solar Home System” Foundation in association
with
JIS University
2 Webinar on “Polymers Science & 8th August, 2020 JIS Institute of Advanced
Technology and 3D Printing” Studies and Research
(JISIASR) Kolkata
3 Workshop on “Web Application 29th September, JIS University
Penetration Testing” 2020 Institutional Innovation
Council.
4 Webinar on “Security In 9th,10th and 11th Department of CSE,
Cyberspace” November, 2020 MBITS

RECORD NOTES OF STUDENTS ACTIVITIES

Sl Event POINTS MAXIMUM POINTS SCORED TOTAL
POINTS SEMESTER
ALLOWED 1 2 3 4 5 6 7 8
1 Moocs (Swayam / 36 40
Nptel/Spoken Tutorial) (Per
Course)
For 12 weeks Duration 20 40
For 8 weeks Duration 16
2 Tech Fest/ Teachers Day/ 8 16
Fresher's Welcome as
Organizer, Participants
Organizer 5 10
Participants 3 6
3 Rural Reporting 5 10
4 Tree Plantation and up 1 10
keeping (per tree)
5 Participation in Relief Camps 20 40

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SIGNATURE OF THE MENTOR SIGNATURE OF THE HOD
Remove this text and put your
 JIS UNIVERSITY
81 Nilgunj Road, Agarpara, Kolkata - 700109
MENTORSHIP FORM
6 Participation in Debate / 10 20
Group Discussion / Tech Quiz
/Quiz
7 Publication of Wall Magazine 16 32
in Institutional Level
(magazine / article / Internet)
Editor 10 20
Writer 6 12
8 Publication in News Paper / 10 20
Magazine and Blogs
9 Research Publication 15 30
Research Publication in 2.5 5
National Conference
Research Publication in 5 10
International Conference
Research Publication in 5 10
National Journal
Research Publication in 10 20
International Journal
10 Innovative Projects (Other 30 60
than Course Curriculum)
Innovative Idea Presentation 5 10
Innovative Model 10 20
Presentation
Innovative Project 30 30
Completion
SL EVENTS POINTS MAXIMUM
NO POINTS
ALLOWED

11 Blood Donation 18 36
Blood Donation Camp 8 16
Participation
Blood Donation Camp 10 20
Organization
12 Participation in Sports / 62 124
Games
College Level 5 10
University Level 10 20
District Level 12 24
State Level 15 30
National Level / International 20 20
Level
13 Cultural Programme 10 20
(Dance, Drama, Elocution,

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SIGNATURE OF THE STUDENT

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SIGNATURE OF THE MENTOR SIGNATURE OF THE HOD
 JIS UNIVERSITY
81 Nilgunj Road, Agarpara, Kolkata - 700109
MENTORSHIP FORM
Music etc.)
14 Member of Professional 10 10
Society
National Organization: 5 10
International Organization: 10 10
15 Member of Student Chapter 10 20
and related activities
National Organization: 5 20
International Organization: 10 20
16 Relevant Industry Visit & 10 20
Report
17 Photography Activities in 5 10
different clubs (Photography
Club, Cine Club, Gitisansad)
18 Participation in Yoga Camp 5 10
(Certificate to be submitted)
19 Self-Entrepreneurship 20 20
Programme
20 Adventure Sports with 10 20
Certification
21 Training to Underprivileged / 15 30
Physically challenged
22 Community Service and 10 20
Allied Activities
(DOCUMENTARY EVIDENCE SHOULD BE PRESERVED BY THE RESPECTIVE
MENTOR & MAINTAINED A STUDENTWISE FOLDER/ FILE SEPARATELY)

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SIGNATURE OF THE STUDENT

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SIGNATURE OF THE MENTOR SIGNATURE OF THE HOD