Erasmus Mundus Doctoral Programme in Sustainable Industrial Chemistry SINCHEM. APPLICATION FORM 2015/2016 Action 1 EMJD

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1 Erasmus Mundus Doctoral Programme in Sustainable Industrial Chemistry SINCHEM APPLICATION FORM 2015/2016 Action 1 EMJD Please select one of category between the two available below: Category A: doctoral candidates from all countries other than the 28 EU member states, the EEA-EFTA states (Iceland, Norway, Lichtenstein), and who are not resident nor have carried out her/his main activity (studies, work, etc.) for more than a total of 12 months over the last five years in these countries. The only exception to this rule applies to Third-Country doctoral candidates who have previously received an Erasmus Mundus masters scholarship in order to follow an EMMC In brief: Category A candidates are Third-country applicants: they cannot come from one of the 28 EU member states and EEA-EFTA state (Iceland, Liechtenstein, Norway). Category B: Any candidate who does not fulfill the criteria of a category A applicant. 1

2 Instructions 1. Save a scanned signed copy of the present application form as a PDF file; the file must be entitled: NAME_ApplicationForm.pdf. 2. Register on-line at the official website of the SINCHEM programme ( after successfully registering, you must login and upload in electronic format as PDF files all requested documents (included in the sequence listed at the end of this form); 3. After successfully submitted your application, you will receive an acknowledgement receipt via . Only applicants with complete application documents will be notified about the reception of the application and will be contacted for further matters; if you do not receive the confirming within 7 days after your submission, please contact us with urgency; 4. This application can be a. submitted on-line OR b. hard copies sent by ordinary mail to the following address: SINCHEM Secretariat Dipartimento di Chimica Industriale Toso Montanari Viale Risorgimento, 4 Bologna Italy Application deadline 20 th of January 2015 Applications received after the deadline will be rejected. It is the applicants responsibility to check that the procedure is correctly accomplished. 2

3 1. PERSONAL DATA (Please enclose a copy of your passport and a passport-sized photo) Family Name: Given Name: Date of Birth: (DD/MM/YYYY) / / Gender: Male Female Place of Birth: Nationality: Marital status : Single Married Registered partnership Number of children: Yes No Do you have a residence permit? Please specify: Do you need a visa for Europe? yes no Please specify: Please note that it is the applicants responsibility to obtain a visa once accepted for this program. 2. CONTACT DETAILS/CURRENT ADDRESS Street, number: P.O. Box: City Country: Postal Code: Phone Number: Fax Number: Skype ID: 3

4 The candidate undertakes to communicate each/any change in residence or address as soon as possible. Person to be contacted in case of emergency: Name: Relationship: Street and number: Postal code: City: Country: Telephone (home number): (country code area code phone number) 3. ACADEMIC QUALIFICATIONS: Please enclose a digital copy of the degree translated into English, the academic transcript containing the list of exams and the scores awarded translated into English and any other academic certificate translated into English. Those who are about to obtain the Master degree must attach the list of exams taken translated into English. A/ Undergraduate Degree(s): Type of degree: Institution: Field/Subject of the degree: Graduation date: Cumulative GPA 1 (Grade Point Average): Ranking (out of how many students): B/ (Post)-Graduate Degree(s): 1 GPA: The cumulative GPA (Grade Point Average) is usually mentioned clearly on your academic transcript. If this is not the case, please ask your university to calculate and provide proof of your cumulative GPA. 4

5 Type of degree: Institution: Field/Subject of the degree: : Specialization: Date of graduation: Cumulative GPA 1 (Grade Point Average): Ranking (out of how many students): Master Thesis Please add in the below fields information on the Master thesis you wrote during the master studies you have indicated before in this application form. Student who did not finished their Master thesis yet are invited to add title, summary and contact details of the institution Tutor. Title of the Master Thesis Contact details of your institution Tutor Summary of the Master Thesis If you have obtained more than one degree, please enclose a list below (please specify the type of the degree, the name of the awarding institution, field of studies, date of graduation): 5

6 4. BACKGROUND: Please enclose a detailed CV (European Format only) and a motivation letter in English. 5. WORKING EXPERIENCE Please provide evidence of your working experience as indicated below A/ Last or current employer: Type of organisation/enterprises/laboratory: Working place: Starting date of the contract: Expiration date of the contract: Position held: Reason for the expiration of the contract: Main duties: Supervisor contact name: Phone: + B/ Previous employer: Type of organisation/enterprises/laboratory: Working place: Starting date of the contract: Expiration date of the contract: Position held: Reason for the expiration of the contract: Main duties: Supervisor contact name: Phone: + C/Previous employer: Type of organisation/enterprises/laboratory: Working place: Starting date of the contract: Expiration date of the contract: Position held: Reason for the expiration of the contract: Main duties: 6

7 Supervisor contact name: Phone: + Other professional information: Relevant skills acquired: 5. COURSES/SEMINARS/CONFERENCES ATTENDED RECENTLY, IF ANY Please provide dates and a brief description 6. LANGUAGES SKILLS Please prove your foreign language proficiency in English language or other languages, by indicating below the following data according to the Common European Framework of Reference for Languages: Mother tongue: Language of instruction of your university Master degree: A/ English Language Proficiency: Date of the test: Score: B/ Other languages Language Listening Speaking Reading Writing A1 Beginner A2 Elementary B1 Intermediate 7

8 B2 Upper intermediate C1 Advanced C2 Proficiency 7. REFERENCES Please enclose two recommendation letters. Such letters can also be sent directly by writers to the SINCHEM address: Recommendation letter 1 Author of the letter: Organisation: Address: Position: Telephone: Recommendation letter 2 Author of the letter: Organisation: Address: Position: Telephone: 8. I WOULD LIKE TO APPLY FOR THE FOLLOWING SINCHEM PROJECTS Please rank the research activity according to your preference (indicate the highest preference with 1, second preference with 2, and so on). Details about the SINCHEM Catalogue at NOTE: Being accepted to the SINCHEM Doctorate does not guarantee that you will be assigned to your research activity preference. Selected applicants will be offered a study track based on availability and, as much as possible, preference. Please indicate four priorities: SINCHEM PROJECT ORDER OF PREFERENCES If you are not assigned to your mobility option or research activity preference, would you still wish to join SINCHEM Doctorate? Yes No 8

9 9. FUNDING Students must be able to finance their study and living expenses. Funding available If yes, what kind: Private funder Actual scholarship Expected scholarship Employer I would like to apply for an Erasmus Mundus action 1 scholarship (in such a case fill in the next form) Please note: EM Scholarships are awarded on the basis of academic and professional merit, not on a needs basis. I would like to apply also without an Erasmus Mundus action 1 scholarship. As a consequence, it will be necessary to pay the participation costs of Euro per semester. 10. SPECIAL CIRCUMSTANCES Please indicate if any physical or learning disabilities that you may suffer from. Do you foresee any personal problems (family, financial and/or cultural)?max. 500 characters Pursuant to the Directive 95/46/EC of the European Parliament and of the Council of 24 October 1995 on the protection of individuals with regard to the processing of personal data and on the free movement of such data, all data and information provided by the applicants/candidates will be used for institutional purposes only, both at national and at international level. I HEREBY DECLARE UNDER MY OWN RESPONSIBILITY that all data entered in the system are true. I AM AWARE THAT, in case of false statements, forgery of documents and use of false deeds, the applicant is prosecuted with penal sanctions under the law. Date Signature 9

10 ERASMUS MUNDUS ACTION 1 SCHOLARSHIP In the last 5 years, have you spent more than 12 months carrying out your main activities (studies, work etc.) in any of the EU member states or in Iceland, Liechtenstein, Norway. No Yes, specify: Have you already benefited from an Erasmus Mundus Joint Doctorate fellowship in the past? No Yes, specify: : Have you already apply to other Erasmus Mundus Master and/or Erasmus Mundus Doctorate for the academic year ? No Yes, specify: : NOTE: Students who already benefited from an Erasmus Mundus Doctoral fellowship in the past are not eligible for a new one. Students can apply for a maximum of 3 different Erasmus Mundus Master Courses (EMMC) and/or Erasmus Mundus Join Doctorate Programmes (EMJD) starting in the same academic year. Students that apply for more than 3 EMMCs and/or EMJDs will be excluded from the selection. Please let us know you learnt about SINCHEM Doctoral programme: SINCHEM website Advertisement in magazine/paper EACEA website Brochure Contact with a partner university Education exhibition Alumni Friends Other, specify: 10

11 DECLARATION BY THE CANDIDATE I ask to be admitted to the selection to participate in the Erasmus Mundus Doctorate in Sustainable Industrial Chemistry - SINCHEM. I certify that: 1. I have read all application instructions and that the information and supporting documents I have provided is accurate, true and correct to the best of my knowledge. I understand that misrepresentation may be a cause for cancellation of my admission or appointment; 2. submission of this application in no way guarantees my right to participate in the SINCHEM Programme; 3. if I will benefit from an EMJD fellowship, I will not benefit from other Community grants while carrying out my Erasmus Mundus doctoral activities; 4. I am not currently under any criminal charges. I agree that this application and accompanying documents will remain with the SINCHEM Consortium, and I authorize the SINCHEM Consortium, in accordance with the Italian privacy law D.Lgs , n.196, art. 13, to treat data provided to the purpose of the candidates selection for the SINCHEM programme. Submitted material will not be returned to me. Place and Date: Name of the applicant : Signature 11

12 APPLICATION CHECKLIST Use the enclosed cover page (see the template available below) If you want to apply for an EM scholarship, you have to fill in the relevant section in the application form DOCUMENTS REQUIRED Please ensure that all the following annexes are enclosed in your application: Detailed Curriculum vitae, Standard European Format only; no other format will be accepted. (see: Certified copy of academic degree(s) in original languages and translated in English, stating the final classification obtained. Certified copies of official transcripts (mark sheets) of academic courses attended to obtain each degree (Bachelor, Master or equivalent) with translation in English, and correspondent Grade Point Average. Signed Motivation Letter in English (maximum one page) specifying: why you have chosen the SINCHEM Programme, which skills and abilities make you a good candidate for SINCHEM, your motivations to carry out research abroad, your professional interests in coming to Europe for education; Two strongly convincing Reference letters signed by a university lecturer, researcher or an expert in the area of Sustainable Industrial Chemistry. Letters must be printed on letterhead and duly signed. Such letters can also be sent directly by writers to the SINCHEM address: Official proof of English language proficiency, providing evidence of the applicant s level of proficiency of the English language. For those who studied in countries where the English is the official language, an official letter stating that your university studies were undertaken in English. Any other qualifications related to the areas of the research dealt with in the course. 1 scanned passport-sized photo Copy of all pages of your international passport. If any of the above required annexes is missing, your application will be considered as incomplete and will be disregarded. 12

13 TEMPLATE COVER PAGE Surname: Full name: Nationality: This envelope contains the following documents: Date: / / DOCUMENT Application form 1. CV 2. Degree certificate/diploma and Academic Transcript 3. Motivation letter 4. Recommendation letters 5. English test result 6. Other qualifications 7. Photo 8. Copy of passport Signature: 13

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