master-globalhealth.demaster-globalhealth.de/.../2017/04/application-form.docx · web viewmaster of...

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Master of Science

in Global Health Risk Management & Hygiene Policies

Application Form

Please fill out the form and sign. Incomplete and unsigned forms will not be considered. Submit this form together with additional applications documents (listed on last page) as a

single PDF file via email to: master.globalhealth@ukb.uni-bonn.de

Personal data:

Family / last name First name I identify my Gender as Female ☐

Male ☐Citizenship(s)Date of birth

Current postal address:

Name (if c/o)Street or P.O. Box (Name & Number)Postal codeCityProvince/State (if any)CountryPhoneI will be contactable at this address for the following timeframe

Permanent Postal address (if differs from above):

Name (if c/o)Street or P.O. Box (Name & Number)Postal codeCityProvince/State (if any)CountryPhone

Online Data:

EmailSkype ID (needed for interview)

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Academic information:

Please include any and all institutions of higher education where you have received academic credit points, including study abroad programmes and additional coursework. If no degree was obtained, please indicate with N/A.

Please keep in mind that for all degrees and coursework listed, you will need to attach a scanned copy of your certified transcripts.

Institution Name (faculty, place & country)

Attendance Degree(date awarded/expected)

Major subject of

study

Credits obtained(in ECTS)

Grade point

average (GPA)

frommm/yyyy

Tomm/yyyy

/ / / / / / / / / / / / / /

Further certificates and courses successfully completed (if any):

Type of course/certificate Name of Institution Datemm/yyyy

/ / / /

List of publicatons (if any):

Professional experience:

Name of Institution Task From - tomm/yyyy mm/yyyy

/ / / / / / / /

Internship during your studies or after:

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Name of Institution Task From - tomm/yyyy mm/yyyy

/ / / / / / / /

English language proficiency (for no-native speakers):

Please keep in mind that for English language proficiency examinations listed, you will need to attach a scanned copy of your original certificate listed score received.

Required for this Master: TOEFL (Paper 550); TOEFL (IBT 79); TOEFL (CBT 213); IELTS (6.5); Cambridge Exam (FCE, CAE); Telc (B2-C1)

Examination Date takenmm/yyyy

ScoreReceived

Choose an item /

I certify that the information given in this application is true, complete and correct to best of my knowledge. I understand that any misrepresentation or material omission made on an Application form or other documents requested renders a candidate liable to instant termination and dismissal. In the event that any information contained within this application changes I am responsible for notifying the coordinator.

Place: ________________________________ Date: ____________________

Signature of applicant: ___________________________________