3-Week PhD Course - Application Form | Supporting nutrition research in Africa | Health Sciences | NWU

Personal details of applicant

Title *

Family name / Surname *

Given name / First name *

Birth Date *

Month

Day

Year

Country of birth *

Nationality *

Marital status *

Telephone number (mobile) *

E-mail address *

Current position/job title *

Workplace *

Address *

City *

Country and postal/zip code *

Educational Background

Full name of institution *

Country *

Degree obtained *

Year obtained *

PhD Registration

Name of institution where registered *

Address of institution *

City *

Country *

Supervisor(s) *

E-mail address of supervisor(s) *

Topic of PhD research *

Year of first registration for PhD *

Which software programme do you use for statistical analysis? *

Publications *

Language Ability

Please rate your English language proficiency from 1 (poor) to 3 (acceptable) to 5 (very good)

First language *

Other languages *

Spoken *

Please rate your English language proficiency from 1 (poor) to 3 (acceptable) to 5 (very good)

Understanding *

Please rate your English language proficiency from 1 (poor) to 3 (acceptable) to 5 (very good)

Written *

Please rate your English language proficiency from 1 (poor) to 3 (acceptable) to 5 (very good)

Professional Activities *

Personal Statements *

Funding

Are you going to apply for funding from CEN-UG? (yes/no).

If yes, write a motivation why you should receive the grant. If no, who will fund your participation in the course?

Motivate *

List other funder *

Official Endorsement

The endorsement form must contain the following information.

This part of the application must be completed by the organisation where you are currently employed. Your application will not be considered unless this part is correctly filled in by the responsible person

Name:

Title and position:

Institution/Organisation:

Address:

Cell phone number:

Email address:

Endorses the application of _________________________________________________ and give permission that he/she may take leave for the full duration of the course.

Signature ______________________________________

Date:

Stamp of the Institution/Organisation

Please upload endorsement letter here *

Additional Information Needed

Your application must be accompanied by a 2-page summary of your PhD research/protocol. Include where you are currently with the research process *

Explain why you chose this particular field of study *

Letter of support from your supervisor to attend the course *

Statement of the applicant

I declare that the above information is true and correct. I undertake to complete the 3-week course if I am selected to attend the course. I agree to provide additional information if needed. *

Yes

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