First Edition (Academic Year 2011-2012)

EUDIME APPLICATION FORM

First Edition (academic year 2011-2012)

The Erasmus Mundus Doctorate in Membrane Engineering (EUDIME) is supported by the Erasmus Mundus programme of the European Union. A number of Erasmus Mundus (EM) fellowships - as an indication, for the first edition this number will be probably 9 - are offered to best selected candidates. The Consortium will make all possible efforts to provide additional no-EM fellowships. Candidates should be aware that the number of fellowships is limited; therefore, candidates may be admitted to the EUDIME Doctorate even while they are not selected for an Erasmus Mundus fellowship.

You are applying (please tick the appropriate box):

only for EUDIME Doctoratefor both EUDIME Doctorate and Erasmus Mundus fellopwship

If you are not awarded an Erasmus Mundus (EM) fellowship, would you still wish to join EUDIME Doctorate (please tick the appropriate box)?

YesNo

Please note that you must write your name as it appears on your identity document.

Surname or family name:

First and other names:

Gender : Male Female Date of birth (dd/mm/yyyy) //

Place and Country of Birth:

Nationality(considered for application):

2nd Nationality (if any):

Passport number: Expiry date (dd/mm/yyyy) //

Identity document (for EU applicant only):

Marital status: Single MarriedRegistered partnership

Number of children:

Address for correspondence:

Street and number:

Postal code:City:

State: Country:

The candidate undertakes to communicate each/any change in residence or address as soon as possible.

It is very important that we get a correct email address because we will contact you mostly by email. In order for you to be certain that you remain a candidate for the programme, you need to check your email regularly and keep us updated on changes in your email address.

e-mail address #1:

e-mail address #2 (if any):

Telephone #1 (home number):

(country code – area code – phone number)

Telephone #2 (mobile number):

(country code – area code – phone number)

Fax:

(country code – area code – phone number)

Person to be contacted in case of emergency:

Name

Relationship:

Street and number:

Postal code:City:

State: Country:

e-mail:

Telephone (home number):

(country code – area code – phone number)

Please enter the details of your previous and current education degree(s) [University Degrees at (and below) Master level and other Higher Education title, specialization etc.] listing the most recentfirst.

Institution (full name):

Street and number

Postal code:City:

State: Country:

Official title and subject of the degree (i.e. Master in Chemical Engineering)

Official minimum duration to obtain degree (months)

Starting date (mm/yyyy): /

(expected) Graduate date(dd/mm/yyyy): //

Cumulative GPA1 (Grade Point Average): Ranking (out of how many students):

1GPA: 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.

Institution (full name):

Street and number:

Postal code: City:

State: Country:

Official title and subject of the degree (i.e. Master in Chemical Engineering)

Official minimum duration to obtain degree (months)

Starting date (mm/yyyy): /

(expected)Graduate date(dd/mm/yyyy): //

Cumulative GPA1 (Grade Point Average): Ranking (out of how many students):

1GPA: 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.

Institution (full name):

Street and number

Postal code: City:

State: Country:

Official title and subject of the degree (i.e. Master in Chemical Engineering)

Official minimum duration to obtain degree (months)

Starting date (mm/yyyy): /

(expected) Graduate date(dd/mm/yyyy): //

Cumulative GPA1 (Grade Point Average): Ranking (out of how many students):

1GPA: 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.

Please enter the details of your most significant professional experience, training or internship, listing the most recent first.

Organization (full name):

Street and number:

City: Country

Position held:

Title of the project:

Starting date (mm/yyyy): / End date(mm/yyyy):/

Main activities and responsibilities (max250 characters)

Supervisor contact name:

email: Phone: +

Organization (full name):

Street and number:

City: Country:

Position held:

Title of the project:

Starting date (mm/yyyy): / End date(mm/yyyy):/

Main activities and responsibilities (max250 characters)

Supervisor contact name:

email: Phone: +

Mother tongue:

Language of instruction of your university Master degree:

Other languages: Please indicate your level in other languages according to CEFR (Common European Framework of Reference):

Note: pre-selected applicants might be interviewed by phone or video-conference to assess their English level.

Please rank the research activity and the corresponding mobility track according to your preference (indicate highest preference with 1, second preference with 2, and so on). Details about the programme are given at:

NOTE: Being accepted to the EUDIME Doctorate does not guarantee that you will be assigned to your mobility option preference. Selected applicants will be offered a study track based on availability and, as much as possible, preference.

Legend: UNICAL: University of Calabria (Italy). UM2: University of Montpellier 2 (France). ICTP: Institute pf Chemical Technology – Prague (Czech Republic). KULEUVEN: Catholic University of Leuven (Belgium). UTWENTE: University of Twente (The Netherlands). UPS: University Paul Sabatier (France).

If you are not assigned to your mobility option preference, would you still wish to join EUDIME Doctorate?

Yes No

Please list the two persons you have asked to write a letter of recommendation for you.

Referee 1

Name:

Title:

Institution/Organization:

Department:

Position:

Address:

Postal code:City:

State: Country:

e-mail: Telephone: +

Referee 2

Name:

Title:

Institution/Organization:

Department:

Position:

Address:

Postal code:City:

State: Country:

e-mail: Telephone:+

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

Please provide here any additional information that may further improve your application (Max 500 characters).

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, Croatia, FYROM and Turkey? (for Third-Country applicants only).

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 2011-2012 ?

No

Yes, specify:

NOTE: Studentswho 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 EUDIME Doctoral programme:

EUDIME websiteContact with a partner university

Advertisement in magazine/paperEducation exhibition

EACEA websiteAlumni

Brochure Friends

Other, specify:

Declaration by the Candidate

Iaskto be admitted to the selection to participate in the Erasmus Mundus Doctorate in Membrane Engineering - EUDIME.

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;

1. submission of this application in no way guarantees my right to participate in the EUDIME Programme;

1. if I will benefit from an EMJD fellowship, I will not benefit from other Community grants while carrying out my Erasmus Mundus doctoral activities;

1. I am not currently under any criminal charges.

I agree that this application and accompanying documents will remain with the EUDIME Consortium, and I authorize the EUDIME Consortium to treat data provided to the purpose of the candidates selection for the EUDIME programme. Submitted material will not be returned to me.

Place and Date:

Name of the applicant:

Signature ______

DOCUMENTS REQUIRED

Please ensure that your application file includes the following required documents (provide them in English, in electronic version as .pdf files, replace «Name» with your family name):

Application form, dully filled out, dated and signed (submit as: Name_ApplicationForm.pdf)

Detailed and signed Curriculum Vitae in English, specifying scientific and professional experiences, academic degrees, publications and special skills. Europass CV template is preferred ( ). Max 3 pages (submit as: Name_CV.pdf)

Copy of all pages of your international passport (preferably) or identification card(submit as: Name_IdentityDocument.pdf).

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 (submit as a single file: Name_AcademicRecord.pdf).

Signed Letter of Motivation in English, covering the following aspects: what made you decide to apply to EUDIME Doctorate, which skills and abilities make you a good candidate for EUDIME, your motivations to carry out research abroad, your professional interests in coming to Europe for education (statement of purpose) must be included in this letter. Maximum one page. The letter must be provided in two copies: one handwritten and one typed (submit as: Name_Motivation.pdf)

Two Reference Letters signed by a university lecturer or an expert in the area of Membrane Engineering. Letters must be printed on letterhead and duly signed (submit as a single file: Name_ReferenceLetter.pdf)

Letter ofResearch Statement, describing a research proposal related to the preferred EUDIME research area (as in paragraph 6). Max 1500 words (submit as: Name_ResearchPlan.pdf)

Official proof of English language proficiency, providing evidence that the applicant’s level of proficiency of the English language (submit as a single file: Name_Language.pdf)

Any other qualifications relative to the areas of the research dealt with in the course (submit as a single file: Name_Qualifications.pdf)

Applicants with disabilities or special needs may apply, if they wish, for special aids and/or additional time to take the entry examination. Applicants who wish to make use of this facility must enclose a medical certificate substantiating the validity of their request with their application form (submit as: Name_MedicalCertificate.pdf).