LAST DATE OF RECEIPT: 5.

00 PM on May 31, 2011

Application No.

MSSS

BIRLA INSTITUTE OF TECHNOLOGY & SCIENCE PILANI, RAJASTHAN - 333 031 First Semester 2011-2012 Application for Admission to M.S. Software Systems

For Office use only

Date of Receipt: ________________________

ID No.

Remarks, if any: _____________________________________________________________________________ Dean Vice-Chancellor

Note: Please read the instructions given at the end carefully before filling in this application form.
SECTION 1: PERSONAL INFORMATION & EDUCATIONAL BACKGROUND 1. Full Name: (in Capital Letters as it appears in degree/ diploma certificate) 2.1 Date of Birth Date 2.2 Age Years 3. 4. 5. 6. Months Affix Unattested Passport Size Colour Photograph Month Year

2.

Sex: (Enter 'M' if Male & 'F' if Female) Do you belong to Scheduled caste or Scheduled tribe? [Y/N] Nationality ('I' if Indian, 'O' if any other) If 'O' to above, specify (a) Father's Name: (b) Mother's Name:

7. 8. 9.

Marital Status (fill in 'M' if Married, 'S' if Single) Do you have access to Internet ? [Y/N] Email address:
(Please be careful about capital / small letters, underscore, hyphen, space etc.. Candidates without access to e-mail / internet access facility will not be considered for the programme.)

10. Can you be contacted by telephone? At Office: (Y/N) At Residence: (Y/N) Mobile Phone: (Y/N) 11. Do you have FAX? (Y/N) STD Code: STD Code: Number: STD Code: Number: 1 of 8 Number: Number:

MSSS ________________________
12. Mailing Address (in Capital Letters) to which all postal correspondence is to be sent: Line 1 of address: ____________________________________________________________________________ Line 2 of address: ____________________________________________________________________________ City Pin / Zip Code 13. Permanent Home Address (in Capital Letters): Line 1 of address: ____________________________________________________________________________ Line 2 of address: ____________________________________________________________________________ City Pin / Zip Code State Country State Country

14.

Educational details from School Leaving Certificate onwards in chronological order:

Subjects / Branch Duration of Diploma / Degree Board / University Year of passing Total Marks Obtained Maximum Marks Final %age of Marks* Div.

Name of Diploma /Degree Class X or equivalent (specify) Class XII or equivalent (specify) Technical Diploma / BSc or equivalent (specify) BITS BS / BE / MSc / MBA / MCA / AMIE or equivalent (specify) Any other (specify) *

As calculated for declaring result and award of Division by your Board / University. If marks are not awarded give Cumulative Grade Point Average or its equivalent. Explain the basis on which your B.E. / M.Sc. / M.C.A. (or equivalent) final percentage is calculated __________________________________________________________________________________ _______________________________________________________________________________________________________

Clearly explain gaps, if any in a separate sheet. 15. Indicate the Level at which you have studied Mathematics. Upto class XII Level fill 1, upto Technical diploma / B.Sc. or equivalent Level fill 2, upto B.E. / M.Sc. or equivalent Level fill 3. Are you currently enrolled for degree or diploma in any University / Institution: (Y/N) If Yes give details specifying the University / Institution name, programme name, duration, date of joining the programme and likely date of completion of the same. ___________________________________________________________________________________________ 17. Have you ever been a student of BITS, Pilani. (Yes / No): if yes, please write name of the degree and your ID No. ___________________________________________________________________________________________ 2 of 8

16.

18. Exam Centre Choice: The evaluation methodology demands the admitted students to come to an Off-Campus centre at Bangalore / Chennai / Delhi / Dubai / Goa / Hosur / Hyderabad / Kolkata / Mumbai / Nagda / Pilani / Pune twice during every semester of study for duration normally during the weekends and at their own expense for taking the Mid-Semester and Comprehensive examinations. Out of these centres, indicate your choice of Examination Centre Note: In case Exam Centre is not indicated the Institute will unilaterally assign a Centre. The Institute is also free to demand that students come to an Exam Centre other than the one indicated above. Further, in case of Dubai centre there will be an additional exam centre fees, which will be indicated at the time of admission.

MSSS ________________________

19. Current Employment Status (E: Employed, S: Self Employed, U: Unemployed) 20. Total Work Experience: Years Months (as on application deadline to be counted only from the point of completing BE / MSc or equivalent) 21. Work Experience in Current Organization: Years Months (as on application deadline to be counted only from the point of completing BE / MSc or equivalent) 22. Employment Details: Since the year of completing BE / MSc or equivalent, give brief employment details below in reverse chronological order. Name of the Employer Designation held Period* of Employment Years Months Days

Total Work Experience calculated after completing BE / MSc or equivalent * Provide the dates of start and end of the employment period. Clearly explain gaps, if any in a separate sheet. 23 Declaration by the Applicant I have carefully read the programme details and the instructions given in this application form and hereby declare that all the information given and statements made in various sections and parts of this Application Form and enclosures are true to the best of my knowledge. I agree to the condition that if any information or statement were found to be wrong, my admission to BITS would automatically be cancelled. I understand that the objective of the Institute will be to examine in detail my educational and professional background along with my employer's visualization of my current and future professional involvement to accommodate my career aspirations within the framework of an appropriate learning avenue. I thus realize that in this process of matching, the Institute instead of rejecting my application for admission may even suggest that I would be more suitable for another degree programme / area of study for which I have not applied. If admitted, I promise to abide by the Rules and Regulations in force or those that may hereafter be made by the Institute and I shall do nothing either inside or outside the Institute which will interfere with its orderly working and discipline. I promise to be regular in the study schedule and in appearing in the examinations at allotted centre. If I am required to come to Pilani for any examination, I shall take permission from my employer for appearing in the same. In the case that I myself will be paying my fees / dues, I affirm that I will regularly pay all fees / dues to the Institute during my programme. Further, in all matters concerning the Institute and myself the decision of BITS Vice-Chancellor shall be binding on me. Place: Signature: Date: Name: 3 of 8

SECTION 2: EMPLOYER CONSENT FORM (This section must be duly filled in by all employed candidates)

MSSS ________________________

Name of Employing Organization : __________________________________________________________________ Name of Employee Employee Number Designation of Employee : __________________________________________________________________ : __________________________________________________________________ : __________________________________________________________________

Date of Joining your Organization : ________________________________________________ (Date / Month / Year) Degree Programme applied for Work Profile of the Employee : __________________________________________________________________ : __________________________________________________________________

_______________________________________________________________________________________________ _______________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ This is to certify that our organization strongly supports and willingly participates in this cooperative effort for conducting the work-integrated learning programme. We feel that this programme will be useful to the employees for their growth and also for our organization. We understand that this programme will be run on the same standard and rigour with which corresponding programmes are run on campus at BITS, Pilani. We agree to give all our cooperation in maintaining its standards. We are willing to participate in this educational process also by nominating a qualified senior professional from our organization / associate organization who will agree to act as a mentor and resource person for strengthening workstudy integration. This mentor will also help in giving suitable organization-based assignments and projects, which will add value to the programme and also will become useful for the organization. In case we are unable to provide mentor from our organization / associate organization, we in principle approve the selection of mentor from another organization as per details in Section 3 of this application form. Regarding the fees for the programme: (Please tick appropriate box): (a) Our Organization will not pay the fees and dues of the employee. (b) Our Organization will partly pay fees and dues of the employee. (c) Our Organization will fully pay all fees and dues of the employee. Note: If you ticked b, what percentage of the fees would be paid by you: Signature of authorized signatory from organization: Name of authorized signatory from organization: Designation of authorized signatory from organization: Address of the Organization:

Date:

Seal of the organization

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SECTION 3: MENTOR CONSENT FORM This form is mandatory for all applicants and the Mentor chosen should have minimum educational qualification of the level of Higher Degree of BITS or its equivalent such as M.E. / M.S. / M.Phil. etc. However, senior professionals holding a First Degree of BITS or its equivalent such as B.E. / M.Sc. / M.B.A. / M.C.A. / M.B.B.S. etc. and having a minimum of 5-years of relevant work experience, may also be proposed as mentors. Preference will be given to applicants having a suitable Mentor from the same employing organization Declaration by the Mentor I have noted that my name has been suggested as Mentor. I have gone through the Information for Mentor given below and I am willing to take up this assignment and will discharge all responsibilities required thereof. Name of Mentor Mentor Qualification University Specialization / Branch Designation of Mentor Name of Organization Mentors Total Work Experience
(as on application deadline)

MSSS ________________________

: ____________ Years ____________ Months : ____________ Years ____________ Months

Mentors Work Experience in current organization

(as on application deadline)

Mentor address (in Capital Letters) Line 1 of address: _____________________________________________________________________________ Line 2 of address: _____________________________________________________________________________ City State Pin / Zip Code _____________________________________________________________________________ _____________________________________________________________________________ ________________________ Country ____________________________________________

Mentor email address: Mentor contact phone no. _____________________________________________

Date:

Signature of Mentor

INFORMATION FOR MENTOR

In the educational methodology for this programme, there is a planned arrangement of periodic interactions in WorkLearning Environment. Your employer's cooperation is sought in creating a Work-Learning Environment at your own organization through guidance to the employee-student by one of the senior officers who would be designated as a Mentor. Such an arrangement would involve four to six hours per week, at most, by this senior officer. The basic role of the Mentor will be to assist the BITS Faculty members in carrying out the academic responsibilities by functioning as a resource person providing valuable guidance based on his / her professional expertise. The salient features of the Mentor's role are summarized below. 1. 2. 3. Each course is conducted with a deadline specified for completion of study of a topic based on the syllabus of the course. Mentor is expected to monitor that the candidate is adhering to the specified study schedule. Each course will have certain evaluation components with specific deadlines. Mentor should again ensure whether the candidate is adhering to these deadlines. To ensure a good relationship between the course and the work of the employee, Mentor may identify study assignments based on the work allocated to the candidate apart from conducting seminars / viva and giving an objective opinion about the progress of the candidate in these components. The Mentor will interact with the student at least thrice a week on mutually agreed days. The Mentor will periodically inform the Dean concerned at BITS Pilani regarding the candidate's progress. During interaction, the Mentor will emphasize self-study and self-learning aspects of the educational process.

4. 5.

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MSSS ________________________
CHECKLIST FOR ENCLOSURES / ATTACHMENTS
Important: Please ensure that you have enclosed the following documents / information without which your application will be considered as incomplete and rejected. You must also ensure that the enclosures are appended in the same order as given below. The very first enclosure must be your Degree Certificate issued by your University. Please Tick ( ) against all those items / documents you have enclosed with this application form. 1. Attested Photocopies of B.E. / B.Tech. / M.Sc. / M.C.A. / A.M.I.E. / M.B.A. / BITS B.S. or equivalent degree certificate issued by your university for your educational qualification and spelling of your name. This must be your first enclosure, failing which your application will be rejected. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. For your date of birth verification attested photocopy of X Pass / Matriculation / Secondary School Leaving Certificate / Marksheet Attested marksheets for all the years / semesters and certificates of all your degree / diploma examinations Experience Certificate(s) towards proof of work experience in current employing organization as well as previous organization(s) wherever applicable. Detailed professional resume of the candidate giving academic & professional achievements including employment details in reverse chronological order. Strong support letter from employing educational institution in case of applicants employed in educational institutions only. Latest brochure giving a detailed profile of the current employing organization. Your detailed work profile duly issued / endorsed by your employer. Details of Research Publications /Patents (if any) submitted by the applicant A write-up on your career objectives in applying to this programme. Detailed resume of your proposed Mentor alongwith an attested photocopy of his/her highest degree certificate. Document giving justification duly forwarded by the applicants employer, wherever the proposed Mentor is not from the same employing organization as that of the applicant. Any other documents like Certificates for short-term course, marriage certificate / Gazette notification for correct name purpose, equivalence certificate if degree diploma is not from University / State Board, etc. Specify ____________________________________________ Demand Draft for the requisite processing fee. DD No.: ______________ Dated _________ for Rs. 1500/- drawn in favour of BITS, Pilani. OR ICICI Bank Challan Branch Transaction ID:______________________ Dated______________ Affix 3 copies of your unattested Passport Size Colour Photograph in the space below.

14.

15.

Affix Unattested Passport Size Colour Photograph

Affix Unattested Passport Size Colour Photograph

Affix Unattested Passport Size Colour Photograph

For Office Use Only: Enclosure verification:

Name ______________________________ Signature _____________________________

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BIRLA INSTITUTE OF TECHNOLOGY & SCIENCE, PILANI http://www.bits-pilani.ac.in/WILP

INSTRUCTIONS TO APPLICANTS Application No . MSSS

1. You must note down your application number and detach this instruction sheet and retain for your own reference.
2.
Please note down the unique application number assigned to the application form when you downloaded the form from the website. This application number must be mentioned clearly in the space provided on the top right corner of each page of the application form. The number of your Application Form is unique. In all subsequent correspondence with the Institute until admissions are finalized make sure that you quote the application number. Failure to do this may make it difficult to connect your correspondence with your Application Form and may cause results to your disadvantage. The Institute will not take responsibility for any negligence on your part. Before filling in this Application Form be sure to carefully read programme details from the Institute website. This Application consists of 3 sections namely, (i) Personal Information & Educational Background, (ii) Employer Consent Form, (iii) Mentor Consent Form and a checklist. All entries should be filled in neatly and legibly in Capital Letters. Enter your name as given in your Final or Provisional Degree / Diploma Certificate issued by University / Board of Technical Education. In the records of our Institute only this name will be incorporated. Pass certificates given by college or polytechnic will not be sufficient. If your name in our records is to be different from the name as given in your degree / diploma certificate then you must enclose supporting documents such as marriage certificate copy, gazette notification copy etc. You must enclose EQUIVALENCE CERTIFICATE issued by an authority such as Association of Indian Universities (AIU) New Delhi, if degree diploma is not from a University / State Board in India or if obtained from a foreign university / institution, etc. The applicant must ensure that an unattested passport size photograph is duly affixed wherever specified in the application form. Enter your date of birth as given in your matriculation / Secondary School Leaving Certificate or equivalent.

3.

4. 5. 6. 7.

8. 9.

10. Whenever a code letter needs to be entered in a box, specific instructions have been given with the item. However in the case of items with (Y / N), "Y" stands for "Yes" and "N" stands for "No". Enter the appropriate letters (either Y or N) as per instructions given in the specific item. 11. Access to Internet and email would be highly desired in the educational process. You are strongly urged to make efforts to obtain access to Internet and email facilities. When writing your email address in the application form you must be careful about capital / small letters underscore, hyphen, etc.. 12. The applicant should take utmost care when filling the Mailing Address and Permanent Home Address. 13. If the applicant is employed, the Employer Consent Form should be duly filled in failing which application will be rejected. 14. If you are employed in an educational institution, then in addition to getting the Employer Consent Form duly filled in, it is mandatory for you to get a strong support letter from the head of your educational institution such as Vice Chancellor or Registrar of the University in their letter head referring your name and application number stating that your undergoing this degree is vital to your institutions development as well as for your career advancement and that your institution strongly supports your candidature for the programme applied. 15. Mentor Consent Form is mandatory for all applicants and the Mentor chosen should have minimum educational qualification of the level of Higher Degree of BITS or its equivalent such as M.E. / M.S. / M.Phil. etc.. However, senior professionals holding a First Degree of BITS or its equivalent such as B.E. / M.Sc. / M.B.A. / M.C.A. / M.B.B.S. etc. and having a minimum of 5-years of relevant work experience, may also be proposed as mentors. Preference will be given to applicants having a suitable Mentor from the same employing organization. 7 of 8

MSSS ________________________
16. All the certificates (photocopies) and other attachments / enclosures should be submitted together with application. Such attachments should be properly fastened at the end of application form with a tag or by stapling. Mark all such attachments on the checklist provided at the end of application. Make sure that all enclosures are appended in the same order as in the checklist. On the top right hand corner of each of your enclosures, you must write your Application Number. All enclosure documents should be given in only A4 size paper, which means that you must enlarge or reduce your document size appropriately. 17. Please check the demand draft for the requisite application processing fee carefully and ensure that it is correct and complete in all aspects such as date, drawee name, bank manager signature, name and Branch Code number of the issuing bank and drawee bank branch, amount in words and figures. Please ensure that the application number and applicants name is written clearly on the backside of the demand draft. In the draft you must ensure that payee / pay to NAME is written only as BITS Pilani and nothing else. 18. Incomplete applications will be summarily rejected. 19. Applications received after the stipulated deadline for submission will be summarily rejected. 20. Considering that this degree is a work-integrated learning programme, it is essential that the applicant be engaged in work in the relevant professional areas. The final offer of admission for such programmes would be based on the applicants educational background, academic achievements, work profile, relevant work experience, profile of the employing organization and proposed mentors profile. 21. Since every student admitted to an off-campus degree programme is treated as a full time student and as a full time employee, it is essential that the student be not enrolled for any degree or diploma programme, part time or otherwise, in any other university. If it is found that a student is already admitted / registered in some other university for degree/diploma programme, then his admission / registration will be cancelled. 22. All admission related queries by email should be addressed to wilpadm@bits-pilani.ac.in alongwith the name of the candidate and application number as given on the top of the application form. 23. The applicant is strongly advised to check the admission status (after the stipulated deadline for submitting filled in forms) from our website http://www.bits-pilani.ac.in/WILP. No separate postal

communication will be sent.

24. The admission offer letter will be made available only through our website. Therefore, applicant who is offered admission must download the admission offer letter from the BITS website and confirm admission offer acceptance as well as registration alongwith fee payment as per instructions given in the website. 25. You are strongly advised to retain a photocopy of the duly filled in application form for your own record. In addition, a photocopy of duly filled in Mentor Consent form should be handed over to the proposed Mentor. 26. After getting admission if the candidate changes job or Mentor he / she must immediately submit consent from new employer / new mentor as per format specified in the Employer Consent Form / Mentor Consent Form given in this application form and also available in our website. 27. This application is valid only for the semester of admission for which the deadline is specified in the first page of this application form. This form will not be valid for admission in future semesters. __________________________

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