GOVERNMENT POLYTECHNIC WASHIM

DEPARTMENT OF INFORMATION TECHNOLOGY

Mentee Information Form
Personal details
Please
Full name of Mentee : affix
Name of mentor : passport
size
Class/ year : Photo

Enrollment No. : Adhar Number:

Date of birth : Blood group:

Mobile No. : E-mail Id:

Permanent address :

Parent’s contact no. :

Local address :

Name of owner : Contact no.

Educational details
S.N. Class Year Result Remark

1 SSC

2 HSC

3 I SEM

4 II SEM

5 III SEM

6 IV SEM

7 V SEM

Medical history if any

Hobbies:

Curricular achievements

co-curricular and extra –curricular achievements

Strength:

Any other remark by mentor

Signature (Mentee) Signature (Mentor)