BITS Pilani | Dubai Campus

APPLICATION FOR ADMISSION TO HIGHER DEGREE PROGRAMME

Fields marked with asterisk ( *) are mandatory

Part-I: PERSONAL INFORMATION

1. First Name * :

Middle Name :

Last Name * :

As given in qualifying examination (12^th grade or its equivalent)

2. Gender * :

Male

Female

3. Date of Birth * :

4. Nationality * :

5. Blood Group :

6. Passport No :

Valid upto * :

Choose file

7.Marital Status * :

8. Do you hold a UAE resident Visa * :

Yes

Visa(File) No.

Emirates ID No:

Valid upto :

9. Address for Correspondence * :

City * :

Country * :

Phone :

Mobile * :

Email * :

10. Father's Name * :

11. Mother's Name * :

12. Emergency Contact No * :

Mobile * :

Email * :

Part-II : ACADEMIC RECORDS *

Qualification	Subjects/ Discipline	Board/ University/ Institute	Duration of the programme	Year of completion	Percentage of aggregate marks/CGPA
10th Grade or Equivalent Enter All Details
12th Grade or Equivalent Enter All Details
B.E. /B.Tech. /__ Enter All Details

If you have ever been on the rolls of BITS, Supply the latest ID No:

Part-III: EMPLOYMENT DETAILS

1. Employment record (list most recent first)

Period		Name & Address of the organization	Designation
From	To	Name & Address of the organization	Designation

Total experience in completed no of years: Years (mention experience beyond the qualifying degree )

2. Information on current employment

Place of work : (Location & City)

Working hours From : To:

Weekend Holidays : (Specify Days)

Part-IVyour preferences: * PROGRAMME PREFERENCES

Indicate preferences for admission to various programmes: [Mark 1,2,3,.. for order of preference against each of the programmes listed below. if you are not interested in a programme, leave it blank.]

M.E. Software Systems

M.E. Design Engineering

M.E. Electrical with specialization in Power Electronics and Drives

M.E. Micro Electronics

Master of Business Administration (M.B.A.)

Part-V: OTHER DETAILS

1. How did you know about BITS Pilani, Dubai Campus?(Select the appropriate boxes) *

Bits Pilani Website

Education/School Fair

(Specify Name)

Online Advertisement

(Specify Name)

Newspaper

(Specify Name)

Referred By BITS Student

(Student Name)

Admission Presentation

(Specify city/country)

(Student Bits ID)

Social Media

(Specify Facebook, Linkedin Twitter,..)

Educational Consultant

(Specify )

2.If any member of your family has studied or is studying at BITS Pilani, Dubai Campus, give details

Name	Relation	ID No./Year of Admission

Part-VI: DECLARATION BY THE APPLICANT

I have read the Admission Bulletin & shall abide by all the conditions laid therein. I further hereby declare that all the information given and statements made in this application and also its accompanying enclosures are true. I agree to the condition that if any information is found to be incorrect, my admission will automatically be cancelled. If admitted, I promise to abide by the rules and regulations the institution and those that may be amended from time to time by the Institution and I shall do nothing either inside or outside the Institution which will interfere with its orderly working and discipline. In all matters concerning me and the Institution, its Hostels, etc. the decision of the Vice Chancellor shall be binding on me.

Place *

Date *

Signature *