An International PhD Programme in Climate Change and Agriculture

Application Form

PhD in Climate Change and Agriculture (CC & Agric)

Université des Sciences, des Techniques et des Technologies de Bamako (USTTB) - Mali; Institut Polytechnique Rural de Formation et de Recherche Appliquée (IPR/IFRA) - Mali; University of Cape Coast (UCC) - Ghana

Female candidates are encouraged to apply.

1. Personal data

Last Name (Family): ……………...... ……………………………………………......
First Name(s): ………………………………………………………………………………..
Gender: Female Male
Date and place of birth: ……/ ……/ ……/ ……………………………………….
Nationality: …………………………………………………………………………….
Marital status: Single Married
Number and age of Children: ……………......
Permanent address: ………………………………………………………………………….
…………………………………………………………………………………………………
Telephone number (compulsory): …………………………………………………………
Email address (compulsory): ……………………………………………………………….
Person to contact in case of emergency Name: ……………………………......
…………………………...... Telephone number(s): ………………………………….
Email address: ………………......


2. Education

2.1. University studies

University attended / Dates of attendance / Qualification obtained / Date qualification obtained
Title of degree awarded and grade

2.2. Post University studies (For Master, DEA, etc)

University name: ......
Date: from ……………………………… to ……………………………………………….
Degree name: ……………………………………………………………………………….
Main Subjects studied: ...... ………………………………………...
...... ………………………………………………………………………...
...... ………………………………………………………………………...
Dissertation title: ………………..……………………………………………………………
…………………………------

3. Language skills

Please indicate using abbreviation L, I or A (L=Low; I=Intermediate; A=Advanced)

Notation
Languages / Reading / Writing / Speaking
L / I / A / L / I / A / L / M / A
English
French
Other

4. Computer skills

Word / Excel / Power Point / SPSS / Others (specify)
Beginner
Working knowledge
Advanced

5. Employment record

Name and address of two previous employers (Please start with your most recent employment ) / Dates of attendance / Position held

List of Application supporting documents

Application file components / Added
Number / Name / Yes / No
1 / Completed application form
2 / Copy of birth certificate
3 / Copy of certificate of nationality
4 / Two recent passport photos
5 / MSc official transcript or equivalent
6 / Transcript of grades for the obtainment of MSc or equivalent
7 / Abstract of the MSc (or equivalent) Dissertation
8 / Transcripts of previous university degrees
9 / Transcript of grades for the obtainment of university degrees
10 / Detailed CV
11 / Letter of motivation: personal statement should include your academic and personal qualities as well as your interests in research in the area of Climate Change and Agriculture
12 / Copy of your pre-proposal, which will be fine-tuned under the guidance of their supervisors, if admitted
13 / Support letter from employer granting study leave, in case of success
14 / Names and adresses of 3 referees, one of whom must be your supervisor in Master studies.

Applicant’s declaration

I, the undersigned, ...... confirm to the best of my knowledge that the information given in this form is true. I take note of the conditions for obtaining a scholarship in CC&Agric and will respect them

Date: …………/…………………/ 201… Signature: ……………………………

WASCAL CC & Agric

Web Sites: www.wascal.org; www.usttb.edu.ml www.ipr-ifra.edu.ml; www.ucc.edu.gh - E-mails: Prof. Ouaténi Diallo: ; Prof. Amoro Coulibaly: ; Dr Benjamin Kofi Nyarko, e-mail ; Selassi Weto: ; WASCAL ;

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