LAST DATE OF RECEIPT: 5.

00 PM on 31st OCTOBER 2007

Application No. MSSS
BIRLA INSTITUTE OF TECHNOLOGY & SCIENCE
PILANI, RAJASTHAN - 333 031
Second Semester 2007-2008
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. 2.1 Date of Birth

Date Month Year
2.2 Age
Years Months

3. Sex: (Enter 'M' if Male & 'F' if Female)

Affix unattested
4. Do you belong to Scheduled caste or Scheduled tribe? [Y/N] Passport Size Photograph

5. Nationality ('I' if Indian, 'O' if any other)

If 'O' to above, specify

6. (a) Father's Name:

(b) Mother's Name:

7. Marital Status (fill in 'M' if Married, 'S' if Single)

8. Do you have access to Internet ? [Y/N]

9. 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) STD Code: Number:

At Residence: (Y/N) STD Code: Number:

Mobile Phone: (Y/N) Number:

11. Do you have FAX? (Y/N) STD Code: Number:

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12. Mailing Address (in Capital Letters) to which all postal correspondence is to be sent:

Line 1 of address: ____________________________________________________________________________

Line 2 of address: ____________________________________________________________________________

City

State
Pin / Zip Code Country

13. Permanent Home Address (in Capital Letters):

Line 1 of address: _____________________________________________________________________________

Line 2 of address: _____________________________________________________________________________

City

State
Pin / Zip Code Country

14. Fill in your educational details from School Leaving Certificate onwards in chronological order:
Name of Subjects / Duration of Board / Year of Total Maximum Final %age Div.
Diploma Branch Diploma / University passing Marks Marks of Marks*
/Degree Degree Obtained
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.B.A. / 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.

16. Are you currently enrolled for degree or diploma in any University / Institution: (Y/N)
If Yes give details specifying the University / Institution name, duration of programme, date of joining the
programme and likely date of completion of the same.

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17. Have you ever been a student of BITS, Pilani. (Yes / No): if yes, please write name of the degree and your ID No.
___________________________________________________________________________________________
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.

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. (a) Since the year of completing BE / MSc or equivalent, give brief employment particulars 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.

(b) Attach your detailed professional resume describing your professional experience in terms of (i) various tasks
of decision making in which you have been involved, (ii) innovations brought about by you, (iii) specific
research or R&D work, (iv) consultancy work, (v) publications, (vi) patents acquired, (vii) awards received etc..

23. Who will pay your fees? (Enter a, b or c):

(a) Full fees by employer (b) Partly employer & partly self (c) Full fees by self

24. If you enter ‘b’ for item 23 indicate the percentage of fees that would be paid by your employer_______________.

25. Mentor available (Y / N) If yes, is mentor from your employing organization (enter Y / N)
If Mentor is not from your employing organization, then you must enclose a document giving justification for the
same, duly forwarded by the employer.
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26. 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:

SECTION 2: EMPLOYER PROFORMA (This section must be duly filled in by all employed candidates)
Name of Employing Organization : __________________________________________________________________
Name of Employee : __________________________________________________________________
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 are willing to participate in this educational process also by nominating
a qualified senior professional who will agree to act as a mentor and resource person for strengthening work-study
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. 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. In addition to the above, regarding the fees for the
programme our organization agrees to one of the following: (Please enter a, b or c in the box):
(a) Our Organization will fully pay all fees and dues of the employee.
(b) Our Organization will partly pay fees and dues of the employee.
(c) Our Organization will not pay the fees and dues of the employee.
N.B.: If you enter ‘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 PROFORMA
This proforma 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 10-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. In case Mentor is not chosen from the same
employing organization as that of the applicant, it is mandatory for the applicant to give adequate justification in a
separate document, which must be duly forwarded by the applicant’s employer.
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
Specialization / Branch
Designation of Mentor
Name of Organization
Mentor’s Total Work Experience : ____________ Years ____________ Months
(as on application deadline)
Mentor’s Work Experience in current organization : ____________ Years ____________ Months
(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 Work-
Learning 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. 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.
2. Each course will have certain evaluation components with specific deadlines. Mentor should again ensure whether
the candidate is adhering to these deadlines.
3. 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.
4. 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.
5. During interaction, the Mentor will emphasize self-study and self-learning aspects of the educational process.
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 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.

Please Tick (
) against all those items / documents you have enclosed with this application form.

1. Demand Draft for the requisite processing fee. DD No.: ______________ Dated _________ for
Rs. 800/- drawn in favour of BITS, Pilani and payable at UCO Bank Vidya Vihar, Pilani (Bank
Branch Code 0150) or SBBJ, Pilani (Bank Branch Code 10398) or for Rs 900/- if drawn at any
other bank (please specify name of the bank) ___________________________. Write your Name
and Application Number on the backside of the Demand Draft.

2. Attested Photocopies of B.Sc. / Technical Diploma / B.E. / BITS B.S. / M.Sc. / A.M.I.E. / M.B.A.
or equivalent degree certificate issued by your university / diploma issued by the Board of
Technical Education for your educational qualification and spelling of your name.

3. Attested marksheets / semesters for all the years of the qualifying examination degree / diploma
examinations.

4. For your date of birth verification attested photocopy of X Pass / Matriculation / Secondary School
Leaving Certificate / Marksheet.
5. Three unattested passport size photographs for examination hallticket purposes.

6. Detailed professional resume of the candidate giving academic & professional achievements
including employment details in reverse chronological order.

7. Experience Certificate(s) towards proof of work experience in current employing organization as

well as previous organization(s) wherever applicable.

8. Strong support letter from employing educational institution in case of applicants employed in
educational institutions only.

9. Latest brochure giving a detailed profile of the current employing organization.

10. Your work profile in your employing organization duly issued / endorsed by your employer.

11. Details of publications (if any) made by the applicant.

12. Details of patents (if any) obtained by the applicant.

13. A write-up on your career objectives in applying to this programme.

14. Detailed resume of your proposed Mentor alongwith an attested photocopy of his/her highest
degree certificate.

15. Document giving justification duly forwarded by the applicant’s employer, wherever the proposed
Mentor is not from the same employing organization as that of the applicant.

16. Any other documents like Certificates for short-term course, marriage certificate / Gazette
notification for correct name purpose, 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.

Specify

For Office Use Only

Enclosure verification
Name: Signature: Date:
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SECTION 4: COMPUTER DATA SHEET Application No. MSSS
Note: This section must be filled in very carefully and the entries must tally with concerned items in earlier Sections. The
application is liable to be rejected if this Data sheet is not filled in properly.

FOR OFFICE USE ONLY Date of receipt:________________

ID No.:
______________________________
1. Full Name:
(in Capital Letters as
it appears in degree/
diploma certificate)
2. Date of Birth:
Date Month Year
3. Sex: (Enter 'M' or 'F'):
4. Do you belong to SC / ST (Y or N):
Affix unattested Passport
5. Father’s Name: ___________________________________________ Size Photograph
6. Mother’s Name: __________________________________________

7. Do you have access to Internet (Y or N):

8. Email address:
9. Current Employment Status (E: Employed, S: Self Employed, U: Unemployed)
10. Employing Organization: _______________________________________________________________________
11. Designation : _______________________________________________________________________
12. Work Experience in Current Organization Years Months
(as on application deadline)
13. Total Work Experience Years Months
(as on application deadline)
14. Mailing Address (in Capital Letters) to which all postal correspondence is to be sent:
Line 1 of address: _____________________________________________________________________________

Line 2 of address: _____________________________________________________________________________

City

State
Pin / Zip Code Country

15. Permanent Home Address (in Capital Letters):

Line 1 of address: _____________________________________________________________________________

Line 2 of address: _____________________________________________________________________________

City

State
Pin / Zip Code Country

16. Telephone at Office:

(with STD Code)
17. Telephone at Residence:
(with STD Code)
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18. Mobile Phone No.:

19. Fax with STD Code:

20. Educational Details:
Name of Subjects / Duration of Board / Year of Total Maximum Final %age Div
Diploma Branch Diploma / University passing Marks Marks of Marks
/Degree Degree Obtained
Technical
Diploma / BSc
or equivalent
(specify)

BITS BS / BE /
MSc / MBA /
MCA / AMIE or
equivalent
(specify)

Any other
(specify)

21. 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.
22. (a) No. of publications (if any): (b) No. of patents (if any):
23(a) Are you currently enrolled for degree or diploma in any University / Institution (Y/N)
(b) Have you ever been a student of BITS, Pilani? If yes, please write name of the degree and your Id Number
______________________________________________________________________________________
24. Who will pay your fees? (Enter a, b or c):
(a) Full fees by employer (b) Partly employer & partly self (c) Full fees by self
25. If you enter ‘b’ for item 24 above, indicate the percentage of fees that would be paid by your employer:
26. Mentor Available (enter Y / N) If yes, is mentor from your employing organization (enter Y / N)

Name of Mentor
Mentor Qualification
Designation of Mentor
Employing Organization
Mentor’s Total Work Experience Years Months
Mentor address (in Capital Letters)
Line 1 of address: _____________________________________________________________________________

Line 2 of address: _____________________________________________________________________________

City

State
Pin / Zip Code Country

Mentor email address:

27. Examination Centre Chosen:

Date: Name: Signature of Applicant:

FOR OFFICE USE ONLY:

Data verifier Name with Signature and Date:
Data entry person Name with Signature and Date:
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 BIRLA INSTITUTE OF TECHNOLOGY & SCIENCE, PILANI
http://www.bits-pilani.ac.in/dlp-home

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.
3. 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.
4. Before filling in this Application Form be sure to carefully read programme details from the Institute website.
5. This Application consists of 4 sections namely, (i) Personal Information & Educational Background, (ii)
Employer Proforma, (iii) Mentor Proforma, (iv) Computer Data Sheet, and a checklist.
6. All entries should be filled in neatly and legibly in Capital Letters.

7. 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.

8. The applicant must ensure that an unattested passport size photograph is duly affixed wherever specified in the
application form.
9. Enter your date of birth as given in your matriculation / Secondary School Leaving Certificate or equivalent.

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 proforma should be duly filled in failing which application will be
rejected. If you are employed in an educational institution, then in addition to getting the employer proforma
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 institution’s
development as well as for your career advancement and that your institution strongly supports your
candidature for the programme applied.
14. Mentor proforma 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 10-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. In case
Mentor is not chosen from the same employing organization as that of the applicant, it is mandatory for the
applicant to give adequate justification in a separate document, which must be duly forwarded by the applicant’s
employer.
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15. 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.

16. The applicant must ensure that his / her name alongwith Application Number is duly written on the backside of
each of the three passport size photographs enclosed for Identity Card purposes. It is advisable that the applicant
keeps the three photographs in a separate sealed envelope with Name and Application Number duly written on the
envelope which should be properly fastened to the application.

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 code of issuing bank
branch and drawee bank branch, amount in words and figures. Please ensure that the application number and
applicant’s name is written clearly on the backside of the demand draft.

18. You should fill in the Computer Data Sheet very carefully, as the data fed to the computer is final. While filling
this sheet, you are required to refer to various sections of the Application Form.

19. Incomplete applications will be summarily rejected.

20. Applications received after the stipulated deadline for submission will be summarily rejected.

21. Considering that the Off-campus Distance Learning and Collaborative degrees are work-integrated
learning programmes, 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 applicant’s educational
background, academic achievements, work profile, relevant work experience, profile of the employing
organization and proposed mentor’s profile.

22. 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.

23. All admission related queries by email should be addressed to dlp-admission@dlpd.bits-pilani.ac.in

alongwith the name of the candidate and application number as given on the top of the application form.

24. 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/dlp-home

25. The admission offer letter will be made available only through our website. No communication regarding
admission status will be sent by post. 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.

26. 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 Proforma should be handed over to the proposed Mentor.

27. 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 Proforma / Mentor Proforma given in this
application form and also available in our website.

28. 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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