Application for

Admission
imec PhD programme
Email: phd@imec.be
To complete the form TAB between entry areas and click on the check boxes to
mark and unmark them.

PERSONAL DATA
Last Name:

Click here to enter text.

Click here to enter text.

Click here to enter text.

First (Given)
Name:
Date of birth:

Country of
birth:
Nationality:
Native

Click here to enter text.

Click here to enter text.

Gender:

Male Female

Click here to enter text.

tongue:
Home/Permanent address:

Present address: (valid till Click here to

Click here to
Click here to
Click here to
Click here to
Telephone

enter text. )
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Mobile
Click here to enter text.

enter
enter
enter
enter

text.
text.
text.
text.
Click here to enter

number:
text.
phone:
Email address:
Click here to enter text.
Marital status: Single Married
Do you intend to marry before you come
Yes

No

to imec ?
Will your spouse join you ?

No

Yes

Page | 1

EDUCATION
Please give details of your academic qualifications including any current studies,
listing your undergraduate studies first.

ACADEMIC DATA
Dates

Name and location

of the institution

Name of studies

Click here
to enter
text.

Click here to enter

text.

Click here to
enter text.

Click here
to enter
text.

Click here to enter

text.

Click here to
enter text.

Click here
to enter
text.

Click here to enter

text.

Click here to
enter text.

From
(dd/mm/yy) to
(dd/mm/yy)

Languag
e of
instructi
on
Click
here to
enter
text.
Click
here to
enter
text.
Click
here to
enter
text.

Qualificatio
n obtained

Grade/
Result

Click here
to enter
text.

Click here
to enter
text.

Click here
to enter
text.

Click here
to enter
text.

Click here
to enter
text.

Click here
to enter
text.

Please provide evidence of your academic qualifications by sending in your Bachelor

and Master certificates and transcripts. The transcripts should show all courses
taken separately, the marks obtained and the maximum and minimum-passing
marks. A rank in class grade point average or percentage should also be given. List
the documents you enclose with your application:
Click here to enter text.

Page | 2

If you have not completed your Master programme at the time you submit your PhD
application, then you are requested to include your examination results available at
the time of submission.
If the transcripts and certificates are not in Dutch, French, German of English, a
translation in one of the mentioned languages must be added.
The certificates and transcripts must be authenticated by an authority of your
country or by the educational institution that issued the documents.

TRACK RECORD
List your honors, rewards and/or publications:
Click here to enter text.
Your teaching or professional experience including summer and term-time work.
Give the name of the employer, dates and nature of work:
Click here to enter text.
Other experience, including military, volunteer work, travel. Give dates and nature
of experience:
Click here to enter text.
Your extracurricular activities and accomplishments:
Click here to enter text.

Page | 3

List the languages you know and indicate your proficiency by marking the
appropriate spaces:

LANGUAGE PROFICIENCY
Comprehensio
n
Language

Click here to
enter text.
Click here to
enter text.
Click here to
enter text.
Click here to
enter text.
Click here to
enter text.

Reading

Writing

Speaking

Ver
y
goo
d

Good

Fair

Very
good

Good

Fair

Very
good

Good

Fair

Very
good

Good

Fair

TEST RESULTS
Please read the general information on our webpage to determine which test results
you need to provide.
Note: Imec does not have an institutional code as we dont need official score
reports
from
ETS.
Please, send in a scan of your test results sheet, along with your application
documents.

GR
E

Test date

Verbal
Reasoning

Click here
to enter
text.

Click here
to enter
text.

TOEFL/IELTS

% below

Click
here to
enter
text.

Test date

Score

Click here
to enter
text.

Click here
to enter
text.

Quantitativ
e
Reasoning
Click here
to enter
text.

% below

Click
here to
enter
text.

Analytical
Writing
Click here
to enter
text.

% below

Click
here to
enter
text.

Page | 4

Cambridge
Test

Click here
to enter
text.

Click here
to enter
text.

Page | 5

APPLICATION INFORMATION
Have you previously applied for admission to imec?

Yes

No

If yes, for which programme?

Master internship programme
PhD programme
Job opportunity
How did you learn about the imec doctoral programme?
Click here to enter text.
Referring to the topics listed on our website, make a list of subjects of your choice.
List them by priority and limit to three. Do not forget to mention the reference
code for each topic you select.
1. Ref code: Click here to enter text.
Topic title: Click here to enter text.
2. Ref code: Click here to enter text.
Topic title: Click here to enter text.
3. Ref code: Click here to enter text.
Topic Title: Click here to enter text.
Any additional information you would like to share:
Click here to enter text.
I declare, upon my honor, that this information is true, complete and accurate.
Date:

Signature: Click here to

enter text.

Page | 6

IMPORTANT REMARKS
Please fill in your answers very carefully. Date and sign the form and send it in pdf
format to phd@imec.be, together with your resume, personal statement and
statement of objectives, copies of your diplomas and mark sheets, and copies of the
required test results. Only pdf forms will be accepted.
We will acknowledge receipt of your application by email. If you do not submit all
the required application documents by the deadline of the application window, your
application will not enter the screening and selection procedure.
Keep certified copies of your academic qualifications readily available as you will be
required to send them in in case of acceptance to the imec doctoral program.

Page | 7