中国科学院中德联合培养博士生项目申请表（英文）.doc

JOINT DOCTORAL PROMOTION PROGRAMME (DPP) REGISTRATION FORM PERSONAL INFORMATION Miss/Ms/Mrs/Mr Registration number (please leave blank) Attach Photo Surname (Family Name), First Name (Given Name) Nationality Date of Birth (day, month, year) Place of Birth Gender □ Male Marital Status □ Single □ Female □ Married Number of Children: ____ Correspondence Address Address to which all correspondence will be sent Permanent Home Address (if different from correspondence address) Address Telephone Fax (if applicable) Email ACADEMIC HISTORY Higher education institutes attended (university, polytechnic college or other) Dates Name of Institution / Place / Country Principal Subject (s) (mm/yy – mm/yy) Degrees awarded or expected before joining the DPP Date of Award Exact Degree Title Subject (day/month/year) (BSc, MSc, Diploma etc.) Score (Marks, Points) Obtained Max.* Min. * * Maximum score (marks, points) that can be obtained, ** Minimum score (marks, points) required to pass Surname, First Name HONOURS, SCHOLARSHIPS, PRIZES List any honours, prizes and awards you have received relevant to this application, with dates and short description THESIS Title of your Master or Diploma thesis, also indicate the name of your supervisor LIST OF PUBLICATIONS, PATENTS ETC REFERENCES First Referee Second Referee Name: Occupation: Address: Phone: Fax: Email: LANGUAGE SKILLS Language native very good good fair poor English □ □ □ □ □ German □ □ □ □ □ □ □ □ □ □ 2 Surname, First Name English Score(s) IELTS  TOEFL  Date Other (please specify) Other information proving English proficiency: OTHER RELEVANT INFORMATION OR REMARKS RESEARCH PROPOSAL 1) PROPOSAL FOR CANDIDATES WITH SUBJECT FOR PH.D. THESIS AND PH.D. CHINA SUPERVISOR IN Title of your Ph.D. thesis Ph.D. Supervisor Name: Position: Address: Phone: Fax: Email: Name three units you would like to go to / that fit your scientific interest: a) Name: Department: City: b) 3 Surname, First Name Name: Department: City: c) Name: Department: City: Write a short research proposal on the scientific work you would like to do if you had the relevant resources and equipment. You are welcome to develop your own ideas. Alternatively you may look up recent publications of relevant members of faculty as a starting point. 4 Surname, First Name FAMILY INFORMATION These details are needed in case your family will join you during your stay in Germany Do you want your family to join you during your stay in Germany? □ Yes □ No Spouse: Surname (Family Name), First Name (Given Name) Date of Birth Place of Birth Children: Surname ( Family Name), First Name (Given Name) Date of Birth Place of Birth Surname ( Family Name), First Name (Given Name) Date of Birth Place of Birth NOTES FOR GUIDANCE Before completing carefully. 1. 2. 3. this registration form, please read the following information Please use A4 size paper only and do not staple. Please either type or complete this form by using block capitals throughout. Complete all sections of the registration as fully as possible. If a section does not apply to you please indicate this with N/A for not applicable. Please do not add any original certificates. STATEMENT I certify that the information provided in this registration form is accurate to the best of my knowledge. I am aware that false answers, whether intentional or the result of negligence, are illegal and that their discovery will lead to the revocation of my registration. Place Date Signature 5