Birla Institute of Technology & Science, Pilani

Dubai Campus
Application No.

SUPPLEMENTARY INFORMATION FOR

ADMISSION WITH ADVANCED STANDING
Academic Year 2016-17

1. Name:

2. Name of the College / University last studied/studying:

3. Name and address of the University to which the above college is affiliated to:

4. Date of Admission: ______________________

5. Name of the Programme Pursued :
6. Duration studied: From ___________ To ___________ Number of years / semesters: ____________
(dd/mm/yy) (dd/mm/yy)

7. Reason for leaving the above College/University:___________________________________________

8. Overall Percentage of aggregate marks secured: ________% or CGPA _______ on ______ Scale.
9. Names of Courses studied, Credits / Units and Marks or Grades obtained in each course ( Attach
official transcript / marks sheet and syllabus of each course)*
Sr. Course Name Credit / Units Marks / Grade
No.

*Applications without these will not be considered

Applicants Sign: __________________