中丹联合培养博士生项目申请表(英文).doc

中丹联合培养博士生项目申请表(英文)Surname, First Name JOINT DOCTORAL PROMOTION PROGRAMME (DPP)REGISTRATION FORMPersonal InformationAttach PhotoMiss/Ms/Mrs/MrRegistration number (please leave blank)Surname (Family Name), First Name (Given Name)NationalityGenderMarital StatusDate of Birth (day, month, year) Male Single Female MarriedPlace of BirthNumber of Children: _Correspondence AddressAddress to which all correspondence will be sentPermanent Home Address(if different from correspondence address)AddressTelephoneFax (if applicable)EmailAcademic HistoryHigher education institutes attended (university, polytechnic college or other)Dates(mm/yy mm/yy)Name of Institution / Place / CountryPrincipal Subject (s)Degrees awarded or expected before joining the DPPDate of Award(day/month/year)Exact Degree Title(BSc, MSc, Diploma etc.)SubjectScore (Marks, Points)ObtainedMax.*Min. * Maximum score (marks, points) that can be obtained, * Minimum score (marks, points) required to passHonours, Scholarships, PrizesList any honours, prizes and awards you have received relevant to this application, with dates and short descriptionThesisTitle of your Master or Diploma thesis, also indicate the name of your supervisorList of Publications, Patents etcReferencesFirst RefereeSecond RefereeName:Occupation:Address:Phone:Fax:Email:Language SkillsLanguagenativevery goodgoodfairpoorEnglishDanishEnglishScore(s)DateIELTSTOEFLOther (please specify)Other information proving English proficiency:Other Relevant Information Or RemarksResearch Proposal1) Proposal for candidates With subject for Ph.D. thesis and Ph.D. supervisor in ChinaTitle of your Ph.D. thesisPh.D. SupervisorName:Position:Address:Phone:Fax:Email:Name of university you would like to go to / that fit your scientific interest:a)Name:Supervisor:Address:Phone:Fax:Email:b)Name:Supervisor:address:Phone:Fax:Email:c)Name:Supervisor:address:Phone:Fax:Email: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. Family InformationThese details are needed in case your family will join you during your stay in DenmarkDo you want your family to join you during your stay in Denmark? Yes NoSpouse:Surname (Family Name), First Name (Given Name)Date of BirthPlace of BirthChildren:Surname ( Family Name), First Name (Given Name)Date of BirthPlace of BirthSurname ( Family Name), First Name (Given Name)Date of BirthPlace of BirthNotes for GuidanceBefore completing this registration form, please read the following information carefully. 1. Please use A4 size paper only and do not staple.2. 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.3. Please do not add any original certificates.StatementI 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. PlaceDateSignature7