Application form ERASMUS MUNDUS


Application form ERASMUS MUNDUS	MA Programme EUROCULTURE Academic year 2010-2011

Please note that the Erasmus Mundus Scholarship for the Euroculture Master programme is open to students who have graduated from an accredited university with an internationally recognized Bachelor's degree in Arts or Humanities.

1. Enrolment Preferences

Please, indicate three different preferred universities for both semesters: Georg-August-Universität Göttingen (Germany), Universidad de Deusto (Spain), Universytet Jagiellonski w Krakowie (Poland), Uppsala Universitet (Sweden), Palacky University Olomouc (Czech Republic) or Rijksuniversiteit Groningen (The Netherlands).

1st Semester		2nd Semester
1st Choice		1st Choice
2nd Choice		2nd Choice
3rd Choice		3rd Choice

2. Personal Information

Surname / Family name	First name(s)


Date of birth (dd/mm/yyyy)	Place of Birth (City)


	Place of Birth (Country)


Nationality	ID card / Passport number


Date of Issue (ID card / Passport)	Expiration Date


Marital state	Number of children


Disabled
Yes* No
*If Yes, please explain here


Gender
Female Male

Mailing Address: (up to Sept. 2010. No PO Box please)

Street	Number


Zip code	Town


Country

Permanent address: (up to Sept. 2010. No PO Box please)

Street	Number


Zip code	Town


Country


Email 1	Email 2


Confirm Email 1


Telephone No.	Fax no.


Mobile No.

3. Educational Background / Academic History

3.1. University Degree

Name & Adress of institution	Course Title & qualification received	Dates of attendance	Level of degree & Final mark (GPA, if applicable)
		Starting year: Final year:
		Starting year: Final year:
		Starting year Final year:

3.2. Additional courses

Name & Adress of institution	Course Title & qualification received	Dates of attendance	Level of degree & Final mark (GPA, if applicable)
		Starting year: Final year:
		Starting year: Final year:

4. Languages

A good command of English (spoken, written, listening and reading comprehension) is a fundamental requirement. Students should have a minimum of 580 for the TOEFL paper based test (Test of English as a Foreign Language) or 92-93 for the TOEFL Internet based test or 237 for the TOEFL computer based test, or IELTS 6.5. The result of a comparable test, such as the Association of Language Testers in Europe (ALTE), or the Council of Europe Framework (CEF) – then the result needs to be on level C1 or C2 – will also be accepted, as will be a Cambridge Certificate of Proficiency. The Designated Institution Code (DI) of our University for TOEFL is: 4431.

Please note: Chinese students should only submit an IELTS score report.

4.1. Indicate the language of your mother tongue

4.2. Indicate the language of instruction of your primary degree

4.3. Indicate if you have taken an English Language Test (TOEFL, IELTS, Cambridge, otherwise)

Yes*No

* If Yes you must include proof of the result with your application

4.4. Language Ability

Please enter each language you are familiar with and rate your abilities (Excellent, Good, Fair or Poor) as appropriate

Language	Read	Write	Speak	Understand

Please, if possible, enclose proof of language courses you have attended.

5. Employment History (paid or voluntary work), relevant to Euroculture

Name & Address of employer	Position Held	Duration of Employment

Please, refer to any other professional experience you may have had (f.i. voluntary jobs)

6. Motivation

State briefly in a separate letter of motivation (no more than one page) the reasons for applying to the MA Programme EUROCULTURE & note briefly any information which you feel may be of relevance to your application.

7. Referees

Please indicate the names and contact details of two academic referees (or one academic and one work related referee) and enclose their reference letters in the paper-based application dossier.

Referee 1:

Name	Name of organisation


Position	Address


Phone No.	Fax No.


E-mail

Referee 2:

Name	Name of organisation


Position	Address


Phone No.	Fax No.


E-mail

8. Masters Degree

Please indicate if you have, or intend to apply to undertake a Masters Degree in any other University and if yes, whether this programme is an Erasmus Mundus Programme or not.

Yes* No

* If Yes, please supply details and state whether or not the programme is an Erasmus Mundus programme:

Title of Course	Name & Address of Institution	Erasmus Mundus
		Yes No
		Yes No
		Yes No

9. Declaration

Herewith I certify that I am a citizen and student of a non-EU country and I respect the rules of the Erasmus Mundus programme. I am not a resident of any of the Member States or the participating countries (EEA-EFTA States and EU candidate countries for accession) and have until 28 February 2010 not carried out my main activities (studies, work, etc.) for more than a total of TWELVE months over the last FIVE years in any of the Member States or the participating countries.

Date:

Town:

Signature (please sign the printed application)

Name:

I hereby declare that the information I have provided is true to the best of my knowledge. By submitting this application I declare that the information I have provided is true to the best of my knowledge.

Security Code: