Off-Campus Thesis Application Form
Uploaded by
Vehaan HandaOff-Campus Thesis Application Form
Uploaded by
Vehaan HandaBIRLA INSTITUTE OF TECHNOLOGY AND SCIENCE, PILANI
K.K. BIRLA GOA CAMPUS
ACADEMIC RESEARCH DIVISION
OFF CAMPUS FIRST DEGREE THESIS / HIGHER DEGREE DISSERTATION
FIRST/SECOND SEMESTER 20….. – 20…..
Form- A
Date:
[To be filled by student for seeking permission for Off-campus thesis/dissertation and to be
submitted to concerned HOD]
a. Name of proposed guide:
b. Name of the department:
c. Full address (Institute’s name, address, Email & Phone No. of the guide):
d. Name and department of proposed co-guide (A BITS, Pilani faculty):
e. Name of host organization/university:
f. Summary of work to be carried out (you may attach separate sheet, if required):
g. Why this work is not possible at BITS Pilani, K K Birla Goa campus?:
h. Financial assistance being offered: Full /Partial/ No(Please tick the right one)
i. If Yes, how much (in Euro/dollar/Rs) per month?
j. Have you done thesis in the previous semester? Yes / No. [Tick the correct option]
k. If yes, provide the details of the earlier thesis station, else leave it blank.
Name
Place
Supervisor’s name,
Email address
Student information:
Name:__________________ ID NO: ________________ Department: ____________________
Email: _________________________ Signature(with date):_______________
Note: Student needs to provide all information which are being asked in the form.
Form-B
Date:
[To be signed by off-campus thesis supervisor, on-campus guide, HOD and
Associate Dean, PS and to be submitted to the HOD by the student]
I hereby agree to guide Mr/Ms______________________________ ID No:______________
on the topic/title____________________________________________________________
_____________________________________________________________________________
I have obtained necessary permissions from my organization for guiding student from BITS
Pilani and will follow the guideline regarding evaluation components and grade submission.
(Signature of off-campus supervisor)
Name of off-campus supervisor:
Name of the Department:
Name of the University / Research Organization:
Email address of the off-campus supervisor:
Phone No of off-campus supervisor::
Complete Postal address:
Date:
For official use
Name & signature (/d) of on-campus co-guide Name & Signature(/d) of HOD
