LAST DATE OF RECEIPT: 23rd MAY 2012

5.00 p.m.

Application No. PH _______________

BIRLA INSTITUTE OF TECHNOLOGY & SCIENCE, PILANI, RAJASTHAN - 333 031 APPLICATION FOR ADMISSION TO PH.D. PROGRAMME This is a downloaded application form. This should be attached to the registration confirmation page printed out by you after registration at BITS website. Otherwise, this form is invalid. This form is only for Ph.D Aspirant candiddates PART I (Read instructions before filling. Tick ( ) the appropriate boxes and strike off options not applicable)

1. (a) Full Name (in Block Letters) ____________________________________________ (as given in your degree certificate) (b) Date of Birth (dd/mm/yyyy) _____________ (c) Gender: Male (d) Nationality: _______________________________ 2. (a) Father's Name: ______________________ (b) Mother's Name: __________________ Email: _________________________________ Female

3. Phone No/.(with STD Code)/ Mobile No. _________________

4. Institution last attended as a regular student and years: ____________________________________________ 5. If you have ever been on the rolls of BITS, provide the latest ID No. ____________________ 6. Employment record: Period* From To

Name & Address of the Organisation

Designation

Nature of Responsibility

7. Academic Record: Details of all Degree/Diploma examinations passed, starting from High school/Higher secondary. (Enclose photocopy of mark sheet and certificate of your qualifying degree) Degrees/ Diploma Year of Passing Duration Examining Authority Aggregate percentage of marks/ CGPA Division Subjects/Discipline

Note: Candidates should account for all the years up-to-date. If there are any failures, gaps or discontinuity in the educational career, they should be explained in a attached sheet. 8. Awards like Merit Scholarships, Gold Medal, NSTS, NTS, etc. that you have received: ______________________________________________________________________________________________ 9. Have you taken any course(s) from the higher degree programme of BITS or equivalent as a part of your first degree (B.E, MSc or equivalent) programme? Yes No If your answer to 9 is 'yes', give the name of the courses(s), year, semester and the grade obtained. 1.________________________________________ 2. ______________________________________

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If you have done any BITS Higher degree or its equivalent (M.E., M.Pharm., M.S., M.Phil.,MBA etc.), give details: (a) Name of the Degree___________________________________________________________________ (b) Name of the Institution ________________________________________________________________

(c)

Duration: From _________ To __________

(d) Part-time or full-time? _____________________

(e) Name of courses and marks (%) or grades obtained (Attach syllabi of all courses, if degree is not of BITS). S.No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Course Name Percentage Marks/Grades Prescribed Text Book

11. If you have ever been a Ph.D. student, (a) Name of the Institution _____________________________________________________________ (b) Duration: From ____________ To ______________ (c) Research topic and supervisor _______________________________________________________ (d) Fellowship (agency and amount) ______________________________________________________ (e) Reasons for discontinuing ___________________________________________________________ 12. Have you ever appeared in a Ph.D. qualifying examination at BITS? If yes, (a) ID No./Appl No. and Year ____________________ (c) Result Pass Fail Yes No

(b) Dates of Examination ___________________ (dd/mm/yyyy)

13. Attach separate sheets giving (i) details of Technical publications/patents (Give title, name(s) of the author(s) and journal in which appeared) and (ii) Professional Attainments & Distinctions. 14. If you have applied to any other degree programme of BITS, give Application No.: ______________ Degree programme: __________________ 15. Give broad topic and out line of research you wish to pursue:

16. Declaration by father or guardian (or employer in case of sponsored candidates): I do solemnly affirm that I shall be responsible for the discipline and conduct of my son/daughter/ward/employee and pay regularly all his/her expenses during his/her stay in the Institute. Place ____________________ Date _________________________________ Designation ___________________________ Signature____________________ Name ___________________________

Address (in case of employer) ___________________________

_________________________________ 17.Declaration by the Applicant: I hereby declare that the information given and statements made in this application and also in its accompanying attachments and enclosures are true to the best of my knowledge. I agree to the condition that if any information or any statement is found to be wrong, my admission to the Institute would automatically be cancelled. If admitted, I promise to abide by the rules and regulations in force or those that may hereafter be made for the administration of the Institution and I shall do nothing which will interfere with its orderly working and discipline. In all matters concerning me and the institution, its hostel, Practice School stations, the decision of the Vice-chancellor shall be binding on me. Place ____________________ Date _________________________________ Permanent Address:________________________ ________________________ Signature____________________ Name ______________________________ PSRN (applicable to BITS faculty only): ____________

Enclosures relevant to Part I (a) Proof of date of birth (b) Photo copy Mark sheet and certificate of qualifying degree (c) Syllabus of Higher degree courses, if holding a higher degree (d) Proof of employment (e) Any other, specify ______________________________________

Application No.: PH _______________ PART I ABSTRACT

(To be filled in by all candidates) 1. 2. 4. Name: ____________________________________________ Sex: Male/Female: ______________ Academic Record: Programme 10 +2 B.A./B.Sc. B.E./B.Pharm/M.A./M.Sc. M.E./M.S./M.Pharm. Any other degree? Division % marks Year of passing Board/Univ. Subjects/Discipline 3. Age: _______ years

5.

lf presently employed, give name of the Organisation: _______________________________________ Employed since when? ______________________________ Broad Topic of Research you wish to pursue:

6.

7.

Special competence and skills, if any?

8.

If you have applied for any other degree programme of BITS, give Application No.: _____________ Name of degree:___________________ YES / NO YES /NO ID No. (if yes): ____________________ Result: PASS / FAIL

9.

Have you ever been a Ph.D. student at BITS? Did you take Qualifying Examination?

Year of appearing in Ph.D. Qualifying Examination: ______________ 10. Permanent Address: _____________________________ _____________________________ _____________________________

Application No. PH ____________ PART II PH.D. ASPIRANTS INFORMATION (To be filled in by applicants for Ph.D. off-campus programme) Tick ( ) appropriate boxes and strike off portions not applicable I.GENERAL 1.1 1.2 Full Name in Block letters _________________________________________ (As given in your degree certificate) Office Address for Communication : _____________________________________ ______________________________________ ________________ PIN___________________ Phone No.: _____________________ Fax No ____________________ Email: ______________________________________ Mobile No: _____________________ 1.3 1.5 II. Nationality: _____________ Date of Birth _____________ 1.4 1.6 Sex: Male Female 1.7 Marital status: Single/Married

Age (in years): ________

EMPLOYMENT RECORD 2.1 If you are presently employed, give details:

Designation:_____________________________ Organisation _____________________________________ Place: __________________________________ 2.2 Employment record Employer Period From To No. of years Designation and nature of responsibilities

Total experience in completed no. of years: ___________yrs. (Mention experience beyond the qualifying degree) III.ACADEMIC RECORD 3. 1 List your qualifications (beyond H.Sc. /10+2) Degree Year of Passing Duration Division/ percentage College/Univ . . On a full/ part time basis Subjects

3.2 List your degrees/diplomas/memberships awarded by professional societies or correspondence colleges. Society/ College Degree/Diploma Year Through exam/Professional experience

3.3 Are you holding a higher degree (M.E./M.Phil./M.Pharm. /M.S. etc.) of BITS or its equivalent ? (Do not tick ( ) Yes if holding only M.A/M.Sc./MBA./L.L.B/M.B.B.S./B.Pharm.) Yes No If yes, give Higher degree name and discipline _________________________________________________ University _________________________________________ Year of Passing ______________ Duration _________________yrs. Completed as a: Full time student No. of courses in the degree _______________________ Part time student Yes No

If No, are your professional attainments equal to the courses of a higher degree of BITS? (Consult Guidelines to Ph.D. Aspirants)

3.4 Outline on a separate sheet of paper claims of your high professional standing and research competence (List and attach documents like research papers, published books, technical reports on innovative product/ process development, etc.) 3.5 What is your motivation for Ph.D. programme (Enter 'Y' against all those applicable). (a) To help further career at job (c) For the benefit of employer/Organisation (b) For personal enrichment (d) An avenue for future employment

(e) Any other, specify _______________________________ IV. ANTICIPATED PLAN FOR Ph.D.

4.1 Place of work (Attach a brief profile of your organization) City ________________________ Organisation _____________________________________________ 4.2 Topic of research ___________________________________________________________________ __________________________________________________________________________________ 4.3 Name of proposed supervisor: _________________________________________________________ Designation and Organisation: ____________________________________________________________ Qualifications: _________________________________________________________________________ Nature of his affiliation with your Organisation: _______________________________________________________ 4.4 Any foreign language other than English required to pursue research in the above topic: ____________________________________________________________________________________________ Note: Please note that there has to be a co-supervisor from the faculty members of any of the BITS, Pilani campuses. (Enclose one typed copy of the details of your research proposal as per the format mentioned in the guidelines , organizational profile in the prescribed format and also enclose copy of supervisor's bio-data and his consent to act as supervisor.)

V.

DETAILS FOR Ph.D. QUALIFYING EXAMINATION Yes No

5.1 Did you ever get permission to appear in the Qualifying examination? If yes, dates of appearing: 1st attempt (month and year) _____________ 2nd attempt (month and year) _____________ Result: Pass Fail

5.2 Details of Higher Degree (M.E./ M.Phil./M.S./M.Pharm., etc.) courses. Attach marksheet, syllabus, and question papers of final examination, if degree is not of BITS. Degree Name: ____________________________ S.No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Course Name Prescribed Text Book

VI.

ANY OTHER INFORMATION YOU WISH TO GIVE

VII.

DECLARATION BY THE APPLICANT

I have carefully read the instructions and I hereby declare that all the information given and statements made in this application and also in other parts of this form and enclosures are true to the best of my knowledge. I agree to the condition that if any information or statement is found to be wrong, my admission to BITS would automatically be cancelled. If admitted, I promise to abide by the rules and regulations in force or those that may hereafter be made by the administration of the Institution and I shall do nothing, which will interfere with its orderly working and discipline. In all matters concerning me and all branches of the Institute, the decision of the Vice-Chancellor shall be binding on me. Place ____________ Date _____________ Signature _________________________ Name ____________________________________

VIII.

EMPLOYER'S RECOMMENDATIONS (To be filled by employer)

8.1 Does you organization have any collaboration with any of the campuses of BITS Pilani? Yes No If Yes then give details about nature of collaboration: PSI PSII Work Integrated Learning Program Sponsored research collaboration Other Give Details_________________________________

If your organization currently does not have any collaboration with BITS Pilani, then please provide a letter of intent from Head of your organization indicating interest and nature of collaboration. 8.2 Tick () below the nature of sponsorship being recommended by you: The Organization is the employer of the student and pays the full fees of the student and also provides the educational facilities for research work. The Organization is an employer of the student but pays only the part fees amounting to Rs. ________ and provide educational facilities for research work. The Organization is the employer of the student but does not pay the fees of the student. Nonetheless, the Organization agrees to encourage the special nature of the educational process for the mutual benefit of the Organization and the employee, and provides educational facilities for research work. 8.3 BITS, under the Ph.D. Aspirants scheme, is catering to sponsored candidates of high professional standing and proven professional competence. It is necessary to examine and match the candidate's aspirations with the organizational goals and facilities that the Organization is able to offer. Please answer the following in the above context:

(a)

Would the Organization be able to suggest a supervisor from amongst the senior professionals/consultant in the Organization for the conduct of the Ph.D. progamme of the candidate? If yes, give name, designation and qualification of the proposed supervisor. Name ___________________________________ Qualification ___________________________________ Designation _______________________________ Organization ___________________________________

If the proposed supervisor is not an employee of the Organization, state below how is he associated with the Organization?

(b)

List below major equipments available with the Organization for research work e.g. computers, analytical instruments, etc.

(c)

State how is the proposed research work suited to the organizational goals:

8.4

Declaration by employer (from an authorized individual of the Organization).

This is to certify, that to the best of our understanding, the information provided by Mr./Ms. __________________ an employee of this Organization is true. The Organization supports his candidature for Ph.D. degree and will provide the necessary educational facilities for research work. Date ________________ Place _____________________ Signature ____________________________ Name ___________________________________ Designation ___________________________________ Name of Organization ____________________________________ Seal ______________________

Application No. PH ______________ PART II ABSTRACT Ph.D. ASPIRANTS INFORMATION Name: _______________________________________________________ Topic of Research ______________________________________________ Designation: __________________________________________________ Organization: ____________________________ City: ________________________ Nationality: ______________________________________________________________ Place of work & Organization. _______________________________________________ Sex: _________ Age: _____________________ Supervisor's Details: Date of birth: ____________________________ Name: _____________________________________ Qualifications: ______________________________________________ Highest Degree: ______________________ Designation: ____________________________________ Discipline: ______________________ Organization: ______________________________________________ University: ______________________________ Year of passing: ___________________ Experience: ____________ No. of Year(s): Address: ____________________________________________________________________________ _____________________________________________________PIN CODE ______________________ STD Code: ______________ Telephone: _________________ Fax:________________ Email:____________________ ------------------------------------------------------------------------------------------------------------------------------------------Check-List of Enclosures by Ph.D. Aspirants. Tick () the boxes. 1. Certificate and Mark sheet of Higher degree (HD) courses (M.E./ M. Pharm./ M.S./M.Phil.) 2. List of Textbooks of all HD courses 3. Syllabus of all HD courses 4. Question papers of final examination of HD courses 5. Professional documents for Higher Degree courses (M.Phil. (Applied) Route) 6. Outline of Proposed Topic of Research 7. Supervisor's consent and his biodata 8. Consent of Supervisor's Organization permitting him to act as supervisor 9. Summary and documents describing high professional standing and competence (item 3.4) 10. Profile of your organization 11. Letter of intent of collaboration if not having collaboration at present 12. Any other, specify ___________________________ Note: Please make sure that all the relevant enclosures are attached with the application form. Incomplete applications will be rejected.

BITS, Pilani

Application No: PH ________________ Detach and Retain INSTRUCTIONS TO APPLICANTS

1. Read the Instructions and our advertisement carefully before filling the Application form. 2. The number of your application form is unique. In all subsequent correspondence with the Institute make sure that invariably you quote this application number. 3. An appropriate declaration by the employer is required for employed and sponsored candidates. 4. Generally all candidates for admission to Ph.D. have to appear for interview/interaction at Pilani at their own expense. 5. If you are a candidate for admission to off-campus Ph.D. programme under Ph.D. Aspirants' scheme, you should fill both Part I and Part II of the application form along with the respective Abstract pages. You should send the application form through your organization duly completed by the deadline. Before filling carefully read the Guidelines for submitting application under 'Ph.D. Aspirants' scheme. Only professionals of high standing and proven competence may apply through this route, which provides for permission to appear in the Ph.D. Qualifying examination even before admission formalities are completed. On successful completion of the qualifying examination, the candidate has to immediately seek admission. Schedule of fee in force at the time of admission shall be applicable to such candidates. 6. For Ph.D aspirant candidates, one faculty member from any of the campuses of BITS, Pilani should act as either co-supervisor or supervisor 7. This scheme is meant for candidates from organizations which are having some collaboration with BITS, Pilani. If candidates organization is currently not having any collaboration then it is essential to establish collaboration with BITS Pilani before the application can be considered.

GUIDELINES FOR SUBMITTING APPLICATION FOR Ph.D. OFF-CAMPUS PROGRAMME UNDER Ph.D. ASPIRANTS' SCHEME A. Information and Documents to be submitted for Ph.D Qualifying Examination Candidates holding a Higher degree of BITS or its equivalent (M.E./M.Pharm/M.Phil./M.S./MBA) and opting to take qualifying Examination on selected two areas based on the course package of this Higher degree: (Each candidate has to indicate two areas for qualifying examination from amongst the areas of research of the respective department. Please visit the respective department website for more details on areas of research.) (a) Marksheet & List of courses and syllabus of each course prescribed for the fulfillment of the higher degree. (b) List of Prescribed textbooks for each course. (c) Final examination question papers for each course. (d) Two areas chosen for the qualifying examination from amongst the areas of research of the respective department Higher degree by Thesis or Research alone is not adequate for the Qualifying examination. Professionals of high standing and proven competence, whether holding a first degree or not but opting to take Qualifying Examination based on professional experience: Should identify the Higher Degree of BITS and its prescribed course package in which Ph.D. qualifying examination is to be taken and to which the professional standing can be notionally equated. As per past experience it its observed that the M.Phil. (Applied) degree of BITS is most suited for many candidates in this category. A list of courses for this degree is given below, from which a minimum number of eight courses are to be chosen. BITS BITS BITS BITS BITS BITS BITS BITS BITS BITS BITS BITS BITS BITS BITS BITS BITS BITS E511 E512 E521 E522 E531 E532 E533 E534 E535 E536 E537 E538 E541 E542 E543 E544 E545 E546 Computer Application I Computer Application II Technical Communication I Technical Communication II Social, Behavioral & Economic Science I Social, Behavioral & Economic Science II Modern Experimental Techniques I Modern Experimental Techniques II Management Methods & Techniques I Management Methods & Techniques II System Sciences and Engineering I System Sciences and Engineering II Chemical and Life Science I Chemical and Life Science II Instrumentation Engineering I Instrumentation Engineering II Project & Consultancy I Project & Consultancy II BITS E547 BITS E548 BITS E551 BITS E552 BITS E561 BITS E562 BITS E571 BITS E572 BITS E573 BITS E574 BITS E583 BITS E584 BITS E591 BITS E592 BITS E593 BITS E594 SKILL G661 SKILL G662 Public Administration I Public Administration II Physical and Mathematical Sciences I Physical and Mathematical Sciences II Use of English for Professional Purposes I Use of English for Professional Purposes II Methods & Planning & Development I Methods & Planning & Development II Study in Advanced Topics I Study in Advanced topics II Case Studies I Case Studies II Science & Technology Development I Science & Technology Development II Reading Courses I Reading Courses II Research Methodology I Research Methodology II

1.

2.

See the BITS website for the course descriptions for above courses to arrive at the correct course package according to one's professional experience.

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For each of the course identified in the above package, technical documents, published papers and reports prepared by the candidate in his professional capacity have to be compiled and submitted. The coursewise documents are examined and a pronouncement of suitability for the purpose of Ph.D. Qualifying examination is made. These documents will broadly form the syllabus besides some prescribed readings. Based on the documents if the candidate is considered eligible for qualifying examination, two areas will be recommended for qualifying examination. 3. Ph.D. Qualifying examination consists of three written papers, each of 2-4 hours duration and an oral test. The written papers are based on the suggested two areas based on the courses of the higher degree of BITS or an equivalent degree from another University of repute and are generally open book. The Qualifying examination will test the candidate's knowledge, grasp of fundamentals and his ability to use them in unknown situations. Additional Information to be provided for deciding overall suitability 1. 2. The proposed place of work and certificate stating availability of facilities for research work by the Organisation. Tentative details of proposed topic of research and supervisor in the format given below: i) Name of the candidate ii) Organisaiton and Place of work

B.

iii)

Name of the Proposed Supervisor, his qualification, designation & Organisational affiliations.

iv) Proposed topic of research v) Background of proposed research vi) Methodology/Work Plan vii) Literature references viii) List of Instruments & equipments needed for research work

ix)
3.

Are these facilities for research work ensured by the Organisation? (Attach certificate.)

x) Other details, if -any i) Proposed supervisor's consent and his biodata ii) Consent of supervisor's Organisation permitting him to act as supervisor iii) Nature of his association with the candidate's Organisation, if working in a different Organisation C. Interview Potential candidates may be called for a face-to-face interaction at Pilani, for which they will be duly informed. They should attend this interaction on the specified dates. No correspondence will be entertained for change of dates of interaction. No TA/DA is paid for attending the interaction. Accommodation in the Institute visiting faculty and student's hostel may be provided on payment basis. D. General Information (a) The Ph.D. Aspirants Scheme is aimed to provide avenues for doctoral research to professionals of high standing and proven competence drawn from Industries, R&D organizations, Government departments etc. having collaboration with BITS Pialni, without being disturbed from their work places. This scheme is not the traditional external registration scheme. (b) Candidates holding only integrated first degree of BITS or equivalent do not normally qualify for admission to Ph.D. under Aspirants scheme unless such candidates have at least 10-15 years of professional experience and are able to submit technical reports and published papers prepared by them in their professional capacity. (c) Candidates holding a first degree and with inadequate experience are advised to apply for admission to M.S. degree programmes of the Institute offered through distance learning. (d) Ensure that all items given in the checklist of enclosures in Part II are submitted along with the application.

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