126 Application Form

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Surname: First names:

EURASIA 2

Application form - 2010/2014 Asian applicants

This application form should be completed in BLOCKletters in order to be easily copiedand/or faxed. Please hand in your application form with ALL the required documents to

your local coordinators.Only fully completed and signed applications can be accepted!

1. APPLICANTS PERSONAL DATA

Family name/Surname __________________________________

(same names as in the passport)

First name(s) __________________________________

Current address __________________________________

(Where you can be contacted) __________________________________

____________________________________________________________________

Permanent address (if different) __________________________________

__________________________________

__________________________________

Phone (with country prefix) __________________________________

Mobile number __________________________________

Fax __________________________________

E-Mail __________________________________

Date of birth (DD.MM.YY) __________________________________

Place of birth, country __________________________________

Sex __________________________________

Nationality __________________________________

Native Language __________________________________

Family status __________________________________

Number of Personal ID Card + expiry date: _______________________________

or International Passport + expiry date: ______________________________

Please mark:PApplicant from Target Group 1*AApplicant from Target Group 2**Applicant from Target Group 3*

*Please check: http://www.eurasia2.cz/page/application-process/

Application for (please choose only one option):pUndergraduates 5 months oro 10 monthsMasters 10 months oro 22 monthsDoctorates 10 months or 34 monthsPost Doctorates 6 months

AcademicStaffS 1 month

2. HOME INSTITUTION

EURASIA 2 www.eurasia2.cz 1

Attach photoPlease

do not staple!
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Full name of the Home Institution (university, company, organisation, research centre

etc.), City:

_____________________________________________________________________________________

Current occupation:

________________________________________________Study years already completed at university (for students):

________________________________________________

Field of Study, of Work:

________________________________________________

Coordinator or contact person of in Asia (full name, phone with country prefix, Email):*Please checkhttp://www.eurasia2.cz/page/partners/

_____________________________________________________________________________________

_____________________________________________________________________________________3. HOST INSTITUTION

Please choose max. 2 host universities from the list of Partner universities.

Institution,Country

Period ofstay fromto(please givemonth andyear)

Field of Study(according to the offer ofthe chosen university*)For PhD/PostDoc/AS:research topic chosen

Durationof stay inmonths

1stpriority

2ndpriority

* Please check the website or contact your chosen universityhttp://www.eurasia2.cz/page/application-documents/4 . PREVIOUS AND CURRENT HIGHER EDUCATION (including studyabroad) :

Study programme Institution Period of study (givemonths and years)

For PhDs, Post Docs: Please specify your doctoral degree:

- PhD degree _____________________________________ 5 . UNIVERSITY DEGREES HELD

Date Exact degree title Subject Result/Finalgrade

http://www.eurasia2.cz/page/partners/http://www.eurasia2.cz/page/partners/http://www.eurasia2.cz/page/application-documents/http://www.eurasia2.cz/page/partners/http://www.eurasia2.cz/page/application-documents/


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Degrees, which will be obtained before a scholarship starts______________________________

Planned date of graduation _____________________________________6 . FOREIGN LANGUAGE COMPETENCE

Languages In this language Ican participateactively in scien.discussionswithoutdifficulties

I havesufficientknowledge tofollow lectures

I would havesufficient knowledgeto follow lectures if Ihad some extrapreparation

_ yes

_ no

_ yes

_ no

_ yes

_ no_ yes_ no

_ yes_ no

_ yes_ no

_ yes_ no

_ yes_ no

_ yes_ no

Language certificates (full name, date, score)_________________________________________

_________________________________________

Please provide a copy of an English certificate required by the university of your choice*!

Language tests, which will be taken before the scholarship

____________________________________Date of test _____________________________________

* Visit the website http://www.eurasia2.cz/page/application-documents/to check the Englishrequirements for the university of your choice.7 . WORK EXPERIENCE RELATED TO CURRENT STUDY

Type of workexperience /

Name of the Institution Period Country

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8 . ONLY FOR STUDENTS (INCLUDING PHD): 2 RECOMMENDATION

LETTERS OF SENIOR ACADEMICS

Please add 2 recommendation letters in a closed envelope.

Title, Name of the

recommendingprofessor

Institution Subject area of the

professors

I certify that the information in this application is accurate. I dont have any psychical orphysical diseases and disabilities, which I have not mentioned in the application andwhich would compromise my participation in the Erasmus Mundus Partnerships Action 2Programme EURASIA 2 Reference: 182724-EM-1-2010-1-CZ-ERAMUNDUS-EMA21-L12. Icertify that I will tell personal changes and additions immediately to the projectcoordinator the Czech University of Life Sciences Prague. I agree that this application andaccompanying documents can be forwarded to partner Institutions, who are cooperatingin this programme.

I certify that I have not resided nor carried out main activity (study, work, etc.) for morethan a total of 12 months over the last five years in one of the European countries.

_______________________________ ______________________________

Place and date Signature of the applicant



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CHECKLIST FOR ENCLOSURES TO BE ADDED:

Please provide English translations of all the documents!

1.CV (EUROPASS see more: http://europass.cedefop.europa.eu/)2.Application letter describing your motivation (max. 3 pages)

3.Academic transcript (an official list of courses you have attended so far, includingGrade Point Average)

4.Copy of your secondary school / high school leaving certificate or universityentrance exam results (only for students)

5.Copy of your bachelors degree or an equivalent amount of ECTS creditpoints (180) if you want to register for a Master programme

6.Copy of your Masters/ diploma degree if you want to register for a PhDprogramme

7.Copy of an English language certificate (please see your chosen universitysEnglish requirements) + other language certificates (if any). It is also ok iflanguage certificate is indicated on the transcript of records.

8.Copy of your passport (page with your picture) or personal ID card, if you do nothave a passport(Candidates finally selected for mobility will be required to obtain an internationalpassport before being able to travel to Europe!)

9.One passport-sized photograph10.Copy of your student ID card (page with your picture)11.For BSc, MSc and PhD students: two recommendation letters of senior

academics12.For Master, PhD, Post-Doc and Academic Staff: 3-page research proposal

including references13.Pleasesee additional documents requested per European universities available on

http://www.eurasia2.cz/page/application-documents/14.If applicable: proof of belonging to target group 3 (e.g. medical certificate or

confirmation of refugee status etc)

After acceptance of your application, you may be requested to have ALLTRANSLATED DOCUMENTS OFFICIALLY AUTHORISED (AND ALL DOCUMENTSCERTIFIED by Embassies/Ministries as requested by your host university) andto submit additional documents (e.g. medical certificates).

http://europass.cedefop.europa.eu/http://var/www/apps/conversion/current/tmp/scratch32600/%20http:/www.eurasia2.cz/page/application-documents/http://europass.cedefop.europa.eu/http://var/www/apps/conversion/current/tmp/scratch32600/%20http:/www.eurasia2.cz/page/application-documents/

Documents

126 Application Form