dls vn engineering scholarship 2013-2014 application form (1).doc

8/14/2019 DLS VN Engineering Scholarship 2013-2014 Application Form (1).doc

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DATALOGIC SCANNING VIETNAM ENGINEERING SCHOLARSHIP 2013-2014 APPLICATIONAPPLICATION FORM

Please comle!e elec!"o#$call%& o" "$#! 'o"m a#( comle!e le)$*l% $# $#+

SECTION 1 - PERSONAL INFORMATION

Al$ca#! Name,

Last name First name Middle name

ID Photo 3 x 4cm

Ge#(e" Male Female Da!e o' *$"!. Month:____ Date_____ Year_____

I(e#!$!% N/m*e", Iss/e( (a!e, Iss/e( lace,

P"ese#! A(("ess Home Tele.o#e,

Mo*$le,

Pe"ma#e#! A(("ess Ema$l a(("ess,

P"e'e""e( co#!ac! a(("ess, ca# !$c+ mo"e !.a# o#e

Present Address Permanent Address Email Home phone Mobile

SECTION 2 - EDCATION

A CRRENT NIVERSIT

Name o' /#$5e"s$!% S!/(e#! ID

Dea"!me#!6Fac/l!% (in English and Vietnamese) Ma7o" o' S!/(%(in English and Vietnamese)

C/""e#! Aca(em$c ea" First Seond !hird Fo"rth Fi#th

To!al #$5e"s$!% E#!"a#ce e8am sco"e,

C/""e#! C/m/la!$5e GPA GPA o' '$"s! semes!e" 'o" 1s!%ea" s!/(e#!

First______ Seond_____ !hird____ Fo"rth______

Tale#! Class,Yes $o

9 HIGH SCHOOL

Name o' .$). sc.ool Loca!$o#, To:#6C$!%6P"o5$#ce

ea" o' s!/(%: #rom __________ to ________ C/m/la!$5e GPA 'o" 3 %ea"s o' .$). sc.ool ,______

C GENERAL

1 T"a$#$#) Oo"!/#$!$es

F"om Mo#!.6ea" ToMo#!.6ea" Name6Desc"$!$o# o' T"a$#$#)

2 Ho#o"s6A:a"(s6Sc.ola"s.$ H$s!o"% (%nl"de amo"nts and e##eti&e dates )

F"om Mo#!.6ea" ToMo#!.6ea" Name6Desc"$!$o# o' Sc.ola"s.$

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3 L$s! o' "ac!$cal "o7ec! ac!$5$!$es $# :.$c. %o/ :e"e $#5ol5e(,

F"om Mo#!.6ea" ToMo#!.6ea" Name6Desc"$!$o# o' "o7ec!s

4 E8!"ac/""$c/la"6Comm/#$!% Ac!$5$!$es (%nl"de shool and omm"nit' ati&ities in order o# importane)

F"om Mo#!.6ea" ToMo#!.6ea" Name6Desc"$!$o# o' Ac!$5$!$es

; E#)l$s. la#)/a)e s+$lls

Sea+$#) L$s!e#$#)


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SECTION 4 - INTERNSHIP

Do 'o" ha&e an' internship ommitments or internship pre#erenes at an' other ompanies7

Yes ________________________________ $o (If &es, please tell the compan& name#

SECTION ; - ESSA IN ENGLISH

'rite an essa& of approximatel& 3 ) * words+ 'e are especiall& interested in learning about &ou, &our

famil&, how &ou became interested in the discipline &ou are stud&ing and future career plans and the reason &ou

are appl&ing for Datalogic canning -ietnam .ngineering cholarship 0103+

2&pe in the next page (font:Arial 18 or 119 reg"laror attach a separate sheet#

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CERTIFICATION AND RELEASE ATHORIATION

% erti#' that all the in#ormation inl"ded in this appliation and attahed do"ments is omplete orret andtr"e to the best o# m' 6no;ledge< % a"thori=e the release o# in#ormation onerning m' ba6gro"nd aademiand #inanial stat"s to on#irm and &eri#' this appliations Signat"re:

SECTION = - RECOMMENDATION FROM THE NIVERSIT

*on#irmed b': _____________________________

!itle: __________________________________

APPLICATION CHECBLIST

!han6 'o" #or ompleting the appliation #orm #or Datalogi Sanning Vietnam Engineering Sholarship Program in?81@4?81< All appliants m"st omplete and sign the appliation #orm and m"st inl"de the #ollo;ing do"ments;ith the appliation pa6age:

Comle!e( al$ca!$o# 'o"m :$!. a 384 .o!o

O''$c$al #$5e"s$!% T"a#sc"$! !o !.e %ea" 2013

E#)l$s. la#)/a)e ce"!$'$ca!es& "ele5a#! "o'ess$o#al assoc$a!$o# $' al$ca*le

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dls vn engineering scholarship 2013-2014 application form (1).doc

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