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Application for Admission / Page 1
Application for Admission to the MSc/PhD/MD-PhD Neuroscience Program COVER SHEET
This pdf file can be downloaded or processed in your browser window. You may enter all relevant information and print the form by using the print button (p. 8). System requirements: Windows PC or Macintosh with Adobe Acrobat Reader 4.0 or higher. Important: Be aware that this file does not allow you to save the information you have entered! All data will be cleared when closing the file, so make sure to print the form before closing it! Please send this cover sheet (p. 1) together with the application form (pp. 2-7), the financial statement (p. 8), two photos and all relevant documents (see checklist, p. 7) in hard copy to our coordination office. A Reference Report Form is available as a separate file. Please forward it to two academic teachers of your choice who are able to evaluate your personality, academic experience and intellectual merit. The reference letters can be included in your application package, preferably in closed envelopes, or can be sent to the coordination office directly by the referees. Prior to sending this application, you need to register online (http://www.gpneuro.uni-goettingen.de). During online registration you will be asked for entering a similar data set as in this application form. Upon successful online registration you will receive a registration number which needs to be indicated below. Notice that online registration serves the purpose of accelerating the selection and admission procedure but DOES NOT substitute for sending this application form and the required documents by post. Deadline for application is January 15 for courses starting in fall of the same year.
This application is intended for enrollment in Registration Number:
(indicate the number you received upon successful online registration)
DO NOT WRITE IN THIS AREA
Last Name: First Name: Middle Name(s): Date of Birth (dd/mm/yy): Nationality: Current Address* / City: Current Address* / Country: Current Address* / State: Latest Degree:
(awarded or expected this year)
AP TR DI R1 R2 EC FS FO C B A
*for correspondence DURING the application and admissions process (i.e. valid until the end of March)
Contact: Prof. Dr. Michael Hörner, Program Coordinator, Grisebachstr. 5, 37077 Goettingen, Germany Phone: +49-551-39 12307/91244, Fax: +49-551-39 12308, email@example.com, http://www.gpneuro.uni-goettingen.de
Flyer.de . specify Contact: Prof. posted at/distributed by Internet Website Friends. Personal Information 1. colleagues. address of parents or relatives) Street Postal Zip Code City State (if applicable) Country Telephone Number Fax Number (if applicable) Please indicate how you learned about the program (check all that apply): Poster. Germany Phone: +49-551-39 12307/91244. Fax: +49-551-39 12308. Dr. 5. specify Other. home address. faculty members. Grisebachstr.de.2. e. other students College or University Office Conference/Workshop/Science or Education Fare.Application for Admission / Page 2 Application for Admission to the MSc/PhD/MD-PhD Neuroscience Program 1. http://www.uni-goettingen.gpneuro. Michael Hörner. Program Coordinator. Children E-Mail Address Registration Number (issued after successful online registration) 1. please indicate the address to be used for correspondence AFTER the application and admissions process.1 Personal Data Last Name First Name Middle Name(s) Date of Birth (dd/mm/yy) Place of Birth (city / country) Nationality male female single married No. firstname.lastname@example.org Current Address: (please indicate the address to be used for correspondence DURING the application and admissions process) Street Postal Zip Code City State (if applicable) Country Telephone Number Fax Number (if applicable) 1. 37077 Goettingen.3 Permanent Address: (if different from 1.
. M. and key results obtained in your thesis project.1 Colleges or universities attended / degrees awarded or expected.de.Sc. *if applicable Contact: Prof.4 *Description of Thesis Project: Briefly summarize experimental approach. gpneuro@gwdg. Michael Hörner. Education 2. methods used. 37077 Goettingen.g.3 *Title of Thesis: 2. 5.) Date of completion 2. Dr. College / University (most recent enrollment) College / University (previous enrollment) Institution Name City Country Enrollment Major Subject(s) Dates attended *Grade Point Average from achieved till max.Application for Admission / Page 3 2. http://www. possible from achieved till max.uni-goettingen. B. Germany Phone: +49-551-39 12307/91244.de .2 *Thesis Advisor: 2. possible Degree Title (e. Fax: +49-551-39 12308. Program Coordinator. Grisebachstr.gpneuro.Sc.
with dates and a short description. awards or other evidence of merit. 2. none = 4) Course Neuroscience Cell Biology Biochemistry Biotechnology Microbiology Botany Zoology Chemistry yes/no / / / / / / / / 1 2 3 4 2.6 Language and Subject Tests: Have you taken or do you plan to take the Test TOEFL IELTS GRE General Test yes/no / / verbal / overall GRE Subject Test in: enter name of test Date (mm/yy) Score quantitative analytical / Language spoken and used for teaching at your educational institution: 2. Fax: +49-551-39 12308. Program Coordinator. Awards In the space below.8 Research and/or Teaching Experience Contact: Prof. list honors.de. Michael Hörner. Dr. scholarships. fair = 3. Please evaluate your background knowledge in each subject (excellent = 1. email@example.com .Application for Admission / Page 4 2. http://www.5 Academic Background / Self-evaluation Indicate whether you attended courses in the subjects listed below for at least 2 semesters. Prizes.7 Honors. 37077 Goettingen. prizes.gpneuro. Germany Phone: +49-551-39 12307/91244. 5. Scholarships. Grisebachstr.uni-goettingen. good = 2.
gpneuro.de . 5. 37077 Goettingen. Fax: +49-551-39 12308. Germany Phone: +49-551-39 12307/91244. Program Coordinator.uni-goettingen. Curriculum Vitae Please list all educational and professional activities in reverse chronological order (from now till the end of high school) without leaving periods of more than one month unmentioned. http://www. gpneuro@gwdg. Dr. From .Application for Admission / Page 5 3. Grisebachstr. Michael Hörner.de.Till Activity Contact: Prof.
Fax: +49-551-39 12308. Describe your specific interests and academic goals. referring to any personal.2 Motivation for Program Entry Please use this page to explain your motivation to pursue advanced study in neurosciences. Interests and Goals 4.de. 5.Application for Admission / Page 6 4. Do not exceed the space provided. 37077 Goettingen. Dr.1 Areas of scientific interests: 4. http://www.3 Non-academic Interests (optional) Contact: Prof. or educational experiences or situations that have contributed to your desire to participate in this program. 4.uni-goettingen. Grisebachstr. Germany Phone: +49-551-39 12307/91244.de . professional.gpneuro. gpneuro@gwdg. Michael Hörner. Program Coordinator.
uni-goettingen. and intellectual merit (in closed envelopes. Dr. Notice that your application can only be processed after we have received your complete application form together with all relevant documents.Application for Admission / Page 7 5. in English or German. Additional Documents (7) Reference Letters: signed letters of two academic teachers who are able to evaluate your personality. (5) 2 Photographs: indicate your name on the back of both photos! (6) Financial Statement (p. I am aware that false answers. Program Coordinator. and that their discovery could lead to the revocation of my admission. Physics or Cell and Molecular Biology is recommended but not required. 8 of this file): 1 copy. 1 copy. (4) Diplomas: certificates of relevant examinations (e. Fax: +49-551-39 12308. in English or German. The use of the attached reference report form is recommended. Germany Phone: +49-551-39 12307/91244. Physikum). preferably mailed directly to the coordination office). (3) Official Transcript / Record of Studies: of all colleges/universities attended. Admission to the program is unaffected by the need for financial aid! Checklist for Application to the MSc/PhD/MD-PhD Program in Neuroscience Required Documents until January 15 (1) Cover sheet (p. Name: Date: Financial Aid / Application for Scholarships There is a limited amount of scholarships available through the program. It is recommended that referees use the reference report form which is available on the program’s website and send the letter directly to the coordination office until January 15. If you intend to apply for one of them. The Subject Test in Biology. http://www. Bachelor’s or Master’s degree. 1 copy of each document. please explain your financial situation on a separate form attached to this application.de . Previous Applications Please indicate whether you have applied to other MSc or PhD programs and whether you have applied for the Neuroscience Program in Göttingen before. References Please list the names. How to proceed from here? After successful completion of your online registration. I affirm the completeness and truthfulness of my responses to the above questions.de. (8) Proof of proficiency in English: if applicable (see website for details). preferably until January 15. Notice that your application will NOT be processed if items 1-6 arrive late or are incomplete. 37077 Goettingen. academic experience.gpneuro. Other Applications. whether intentional or the result of negligence are illegal. I am in consent with the storage of my personal data for application and admission purposes. Applications at other places or previous applications in Göttingen will not affect decisions in this application cycle! Assurance of complete and truthful information and statutory declaration I submit my application for admission to the Msc/PhD/MD-PhD Neuroscience Program with the above information. acceptable after the application deadline. Vordiplom. Deadline for submission is January 15 of the year in which you intend to enter the program. e-mail addresses and phone numbers of two referees who will write letters of recommendation for you. Optional (9) GRE Scores: official score reports of the Graduate Record Examination. 2-7 of this file): 2 copies of completed application form (signed). Chemistry. (2) Application Form (pp. please send all documents listed in the checklist above to the program coordination office by air mail or surface mail. Grisebachstr. 5. Michael Hörner. reference letters submitted after January 15 will not be acknowledged in the evaluation of your application. 1 of this file): 1 copy.g. gpneuro@gwdg. positions. 6. Late or incomplete applications will not be accepted! Contact: Prof.
de . 37077 Goettingen. Two hard copies of the entire file need to be submitted to the coordination office.uni-goettingen. Dr. Michael Hörner. Program Coordinator.gpneuro. please explain your financial situation: Printout Please use the button below for printing this file. Grisebachstr. Germany Phone: +49-551-39 12307/91244.de. Contact: Prof.Application for Admission / Page 8 Financial Statement (required from all applicants) Please state here how you plan to meet the full expenses of your stay in Göttingen. http://www. If you intend to apply for one of them. Fax: +49-551-39 12308. Be reminded that this file does not allow you to save the data you have entered! All data will be cleared when closing the file. 5. gpneuro@gwdg. Germany (minimum amount required: 500 Euros per month): Do you require financial aid and want to apply for a scholarship through the program? Admission to the program is unaffected by the need for financial aid! yes no Application for Financial Aid (optional) There is a limited amount of scholarships available through the program. One hard copy should be kept for your records.
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