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 FORM

Personal Information

Attach Photo
Miss/Ms/Mrs/Mr
Registration number (please leave blank)

Surname (Family Name), First Name (Given Name)

Nationality

Gender
Marital Status
Date of Birth (day, month, year)

□ Male

□ Single

□ Female

□ Married

Place of Birth

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
(mm/yy – mm/yy)

Name of Institution / Place / Country
Principal Subject (s)

Degrees awarded or expected before joining the DPP
Date of Award
(day/month/year)
Exact Degree Title
(BSc, MSc, Diploma etc.)
Subject
Score (Marks, Points)
Obtained
Max.*
Min. *

* Maximum score (marks, points) that can be obtained, ** Minimum score (marks, points) required to pass

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
□
□
□
□
□
Danish
□
□
□
□
□

□
□
□
□
□

English
Score(s)
Date
IELTS –

TOEFL –

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. supervisor in China

Title of your Ph.D. thesis

Ph.D. Supervisor

Name:

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 Information
These details are needed in case your family will join you during your stay in Denmark

Do you want your family to join you during your stay in Denmark?

□ 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 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.

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

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