National University of Kyiv-Mohyla Academy

INTERNATIONAL rESEARCHSTUDENT[1]

APPLICATION FORM

Please provide complete information for each item requested. Please type or print clearly.

PERSONAL DATA

  1. Last (family) name______
  2. First (given) name______
  3. Middle name______
    Sex male______female______
  4. Date of Birth (month/day/year)______Place of Birth______
  5. Citizenship______
  6. Permanent Address______

______

  1. Present (mailing) Address______

______

  1. Telephone______Fax______E-mail______

10. Please, fill in the table below according to your EDUCATION experience

Institutions attended above high-school level / Dates attended
(month/year)
from to / Degrees received
or expected / Fields of study
Major (minor if applicable)

11. Name and address of the person in your home country to be notified in case of emergencyand his / her contact information

______

12. Passport Information

Passport Number______

Indicate the issuing country and the day through which your passport is valid:

Country______Date of Expiration______

RESEARCH INFORMATION

13. Proposed period of your stay in Ukraine[2]: from______(month/year)to______(month/year)

14. Please indicate the academic discipline and field of study which is primary for your project proposal

15. Provide keywords (appr. 3-5) to categorize your project area______

16. What is the title of your proposed research? ______

17. In which Faculty/Department would you like to be affiliated?______

18. Do you already have any contacts with NaUKMA faculty member[3]? (if yeas, provide the details)

19. Do you intend to take any courses at NaUKMA (including Ukrainian Language for International Students)[4]?______

20. Please, indicate your level of English and Ukrainian:

English:

Poor / Fair / Good / Excellent
Academic Reading
Academic Writing
Oral Comprehension
Special English
(your specialization)

Have you ever took the Test of English as a Foreign Language (TOEFL) or other equivalent(e.g. ELTS)

Name of Test______

Date______

Location______

Score______

Ukrainian:

Poor / Fair / Good / Excellent
Academic Reading
Academic Writing
Oral Comprehension
Special English
(your specialization)

21. When and how did you study Ukrainian?

______

Additional information you would like to share about your stay (health, diet, etc.) ______

______

ACCOMMODATION

I have a private housing in Kyiv at the following address ______

I would like to stay at NaUKMA dormitory, double room (specify period of your stay) ______

Iplan to find a private housing_____I need assistance in finding private housing (please provide requirements to an apartment, e.g. you would like to say alone or to share apartment)______

______

I plan to find a full/part board family accommodation______I need assistance in finding a full/part board family accommodation (please provide your requirements to the family accommodation) ______

______

ATTACHMENTS

In addition to this completed form, your application must include the following:

1. Applicants must submit certified copies of academic credentials (transcripts / diplomas /certificate etc.). An official document issued by your university/college which lists courses, course hours and grades received, and an explanation of the grading system.

2. Academic credentials must be translated into English or Ukrainian. The translated document must be signed and stamped by an officially certified translator. If a translation of your documents is necessary, you must submit both the original language copy and the translated version of your academic credentials.

3. Short description (max 1 page) of your research project to plan to conduct at the NaUKMA

4. Curriculum Vitae.

5. Two passport size recent photos.

I certify that I have provided complete and accurate answers to the questions of this application to the best of my knowledge. I further certify that all official documents submitted in support of this application are authentic and unaltered records that pertain to me.

Date ______Signature______

Please send application form, CV and research project description via email

International Education Programs Advisor for Faculty and PhD Students

International Office

Altogether full application (application form with all 5 listed above items) must be send via postmail to:

Mariia Vasylets

Deputy Head, International Office

International Office

NationalUniversity of Kyiv-MohylaAcademy

2, Skovoroda St.,

Kyiv04070, Ukraine

ATTENTION! Application must arrive to International Office, NaUKMA not later then 1 month prior planned research visit.

[1] Being a research student you will concentrate on the research work / collecting data for you topic of interest under the supervision of the NaUKMA faculty member. The maximum duration of research at NaUKMA is 2 years.

[2]Pay attention that research visits are impossible during summer vacation period at NaUKMA 1 July-31 August.

[3]In case you don not have any previous agreements with your potential research supervisor at NaUKMA, Department for Foreign Cooperation will do that on the basis of the information provided in this application and attached documents. Every international research students is supposed to have a research supervisor during his / her research period of NaUKMA.

[4]For more information about Courses taught in English check. Status of NaUKMA research students anticipate a possibly of auditing (without getting credits) NaUKMA courses upon the approval of the faculty member, teaching the course.