PEMP Application Form
PEMP Application Form
PEMP Application Form
Application Form
Year of Entry: Part-Time Course
M.Sc.[Engg.] MBA Corporate M.Sc.
Full-Time
Organisation
(For Corporate M.Sc course only)
Form 65
Ver: 7
Date: 01-06-2011
Page 1 of 4
1.
Date of Birth
Permanent Address:
Ph.
PIN:
Ph.
2. Year of Entry
Award of Degree
S. No 1
2 3 4 5 6 7 8 9 10 11 12 13
Order of Preference
S.N o
14 15 16 17 18 19 20
Courses
Machinery Design Machine Tool Design and Technologies Product Design Real Time Embedded Systems Rotating Machinery Design Signal Processing and Communication Technologies Strategic Product Design Management VLSI System Design MBA in Engineering Operations MBA in Finance & Accounting MBA in Human Resource Management
Order of Preference
Commercial and Retail Design Computer Animation and Games Development Computer Science and Networking Digital Signal and Image Processing Engineering and Manufacturing Management Electrical Machines and Power Engineering Electronics Systems Design Engineering
21 22 23 24
25
Form 65
Ver: 7
Date: 01-06-2011
Page 2 of 4
3.
(Please tick appropriate item)
Academic Details
B.E or Equivalent M.Sc B.Sc Course / Main Subject Educational Institution/ College / University Year From To Grade/ Class Technical Diploma / Equivalent Others (Please Specify)
S.No 1 2 3
4.
S.No 1 2 3 4
Work Experience
Organization and Job Title Brief description of work Duration
(months)
Part-time/ Full-time
5.
References
Please give details of two people who have been involved in supervising your recent academic work. If you have not been in education for a number of years please give the name of your current employer instead of one academic referee. When required, referees will be contacted by mail, fax or telephone.
6. a b c d
If (c) or (d) is ticked, state to what extent you will be financed and give the address of your employer/Government:
Form 65
Ver: 7
Date: 01-06-2011
Page 3 of 4
7.
Additional Information
Please provide any relevant information, which may help the admission committee with your selection.
Signature
Date
Instructions to Applicants:
Filled in applications should be sent to Manager- Admissions along with the following: 1. Documents and fees to be submitted along with application: Sl. No. 1 Category For ALL admissions 1. 2. 3. 1. 2. 1. 2. 3. 1. 2. 3. Fees and Photocopies of Documents Application and prospectus fee in the form of a DD Registration fee in the form of a DD Caution deposit in the form of DD (at the time of admission) 10 and 10+2 Marks cards Degree certificate 10 / 10+2 Marks card Diploma certificate Experience certificate (Min 3 Yrs) 10 and 10+2 Marks cards Degree Certificate Experience certificate (Min 3 Yrs)
Engineering Graduate
Diploma holders
4 1. 2. 3.
ONLY photocopies of the above documents should be submitted. The Original documents should be produced at the time of admission for verification. DD must be drawn in the favor of M S Ramaiah School of Advanced Studies- Bengaluru
Incomplete applications and applications without the prescribed fees will not be considered for admissions. In case admission is not offered or the applicant has not joined the course, the registration fees will be returned after 8 weeks from the date of commencement of the course.
Contact Details:
Manager-Admissions M.S.Ramaiah School of Advanced Studies #470 P, Peenya Industrial Area, 4th Phase, Peenya, Bengaluru 560058. India For Office Use: e-mail: admin@msrsas.org Ph.No: (080) 49065555 Fax: (080) 42111205 Website: www.msrsas.org
Form 65
Ver: 7
Date: 01-06-2011
Page 4 of 4