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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: Country of birth: Nationality: Native tongue: Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Gender: Male Female First (Given) Name: Date of birth: Click here to enter text. Click here to enter text.

Home/Permanent address: Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Telephone number: Email address: Click here to enter text. Click here to enter text.

Present address: (valid till 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. Mobile phone: Click here to enter text.

Marital status: Single Married Do you intend to marry before you come to imec ? Will your spouse join you ? Yes Yes No No

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

ACADEMIC DATA
Dates
From (dd/mm/yy) to (dd/mm/yy)

Name and location of the institution Click here to enter text.

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.

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Language of instruction Click here to enter text. Click here to enter text. Click here to enter text.

Qualification obtained Click here to enter text. Click here to enter text. Click here to enter text.

Grade/ Result 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.

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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.

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

LANGUAGE PROFICIENCY
Comprehension 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.
Very good Good Fair Very good

Reading
Good Fair Very good

Writing
Good Fair Very good

Speaking
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.
Test date Click here to enter text. Verbal Reasoning Click here to enter text.
Test date

% below Click here to enter text.


Score

Quantitative 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.

GRE

TOEFL/IELTS

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

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

Cambridge Test

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APPLICATION INFORMATION
Have you previously applied for admission to imec? Yes 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. Ref code: Click here to enter text. Topic title: Click here to enter text. Ref code: Click here to enter text. Topic Title: Click here to enter text. No

2.

3.

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: Click here to enter a date. Signature: Click here to enter text.

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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.

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