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Application Form Graduate Research Programme on Climate Change and Water Resources University of Abomey Calavi,, National Institute for Water, B.P. 526 Cotonou, Benin.
1. Personal data
Last Name (Family): ……………...... ……………………………………………......
First Name(s): ………………………………………………………………………………..
Gender: Female ……………Male
Date and Place of Birth (dd/mm/yy): …………………………………………………….
Nationality: ………………………………………………………………………………….
Marital Status: ………………………… Number and Age of Children: ……………….
Country of Residence: ………………………
Permanent Home Address (compulsory; preferably with street name and house number)………………………………………………………………………………………………………………………………………………..
Telephone Numbers (compulsory) :………………………………………………………….
Primary Email Address (compulsory): ……………………………………………………..
Skype Address (compulsory)
Name of Contact Person in Benin (for emergencies) Name: ……………………………..
GSM number(s): ……………………… Email / Skype address: ………………......
2.Universities and Obtained diplomas (e.g.Bsc, MASTER or equivalent).
Universities Attended
Year of Attendance
Qualification Obtained Date of Qualification Obtained
Title of Degree Awarded and Grade
Subject ( of Master Course) Studied: …………………………………………………………………….
Title of Dissertation: ……………..……………………………………………………………
…………………………………………………………………………………………………
Period of Study: From ……………………………… To ………………………………….
3 Language skills
For Applicants from Francophone Countries possessing TOEFL Certificate will be an added advantage.
Languages: ( fair, good, Excellent)
Reading Writing Speaking
English
French
Others
4. Computer skills
WordExcelPower PointSPSSOthers (specify)
Beginner
Working knowledge
Advanced
5. Employment record
Name and Address of two previous employers (Please start with your most recent employment ) , dates of employment and Position held
6.Letter of motivation
Personal statement should include the student’s academic and personal qualities as well as his/her interests in research in the area of Climate Change and Water Resources
7. Application supporting documents
(All relevant documents must be sent for the applicant to be considered for admission)
Completed application form (Partially completed forms WILL NOT be considered)
Candidates must submit B.Sc. or B.Tech Certificate or equivalent
Candidates must submit B.Sc or B.Tech Official Transcript or equivalent
Detailed Curriculum Vitae (CV)
Letter of motivation
Two (2) recent passport photographs
Letter of attestation of good behaviour from the applicant’s parents/ guardian with detailed contact address and phone numbers (s)
Support Letter from employer (if employed) granting study leave for duration of the programme, excluding the period for the language course
Copy of Certificate of Nationality or State of Origin
Both soft (in a CD) and hard copies of the applicant’s research pre-proposal or research interest as indicated in item 6 above
Applicants must submit recommendation letters from three (3) referees: his/herMaster degree Project Supervisor, Head of Department and any other. If employed, the third letter must come from the immediate supervisor/boss in his/her work. The letters must contain detailed functional contact addresses (e-mail, skype and postal etc) and telephone numbers of the referees.
Female candidates are encouraged to apply.
All Required Documents are to be scanned into Pdf submitted along with the application to: ;; and copy ;
I confirm to the best of my knowledge that the information given in this form is true.
Date:…………/…………………/ 2015 Signature: ………………………….
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Campus Universitaire d’Abomey-Calavi (UAC) 01 B.P. 526 COTONOU – Tél. (229) 21 36 00 74 – 94 06 23 65 / 67 25 88 42 / 90 94 20 33
E-mail :