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Application form - 2010/2014 Asian applicants This application form should be completed in BLOCK letters in order to be easily copied and/or faxed. Please hand in your application form with ALL the required documents to your local coordinators. Only fully completed and signed applications can be accepted! 1. APPLICANTS PERSONAL DATA Family name/Surname __________________________________ (same names as in the passport) First name(s) __________________________________ Current address __________________________________ (Where you can be contacted) __________________________________ __________________________________ __________________________________ Permanent address (if different) __________________________________ __________________________________ __________________________________ Phone (with country prefix) __________________________________ Mobile number __________________________________ Fax __________________________________ E-Mail Date of birth (DD.MM.YY) Place of birth, country Sex Nationality Native Language Family status __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ _______________________________ ______________________________
Attach photo Please do not staple!

Number of Personal ID Card + expiry date: or International Passport + expiry date: P Please mark: A Applicant from Target Group 1* Applicant from Target Group 2* * Applicant from Target Group 3*

*Please check: http://www.eurasia2.cz/page/application-process/

Application for (please choose only one option): p Undergraduates 5 months or o 10 months Masters 10 months or o 22 months Doctorates 10 months or 34 months Post Doctorates 6 months Academic Staff S 1 month 2. HOM INSTITUTION E
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Full name of the Home Institution (university, company, organisation, research centre etc.), City: _____________________________________________________________________________________ Current occupation: ________________________________________________ Study years already completed at university (for students): ________________________________________________ Field of Study, of Work: ________________________________________________ Coordinator or contact person of in Asia (full name, phone with country prefix, Email):
*Please check http://www.eurasia2.cz/page/partners/

_____________________________________________________________________________________ _____________________________________________________________________________________ 3. HOST INSTITUTION Please choose max. 2 host universities from the list of Partner universities. Institution, Country Period of stay from to (please give month and year) Field of Study (according to the offer of the chosen university*) For PhD/PostDoc/AS: research topic chosen Duration of stay in months

1st priority

2nd priority

* Please check the website or contact your chosen university


http://www.eurasia2.cz/page/application-documents/

4. PREVIOUS AND CURRENT HIGHER EDUCATION abroad) : Study programme Institution

(including study Period of study (give months and years)

For PhDs, Post Docs: Please specify your doctoral degree: - PhD degree _____________________________________ 5. UNIVERSITY DEGREES HELD Date
EURASIA 2

Exact degree title

Subject

Result/Final grade
2

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Degrees, which will be obtained before a scholarship starts ______________________________ Planned date of graduation _____________________________________ 6. FOREIGN LANGUAGE COM PETENCE Languages In this language I can participate actively in scien. discussions without difficulties _ yes _ no _ yes _ no _ yes _ no I have sufficient knowledge to follow lectures _ _ _ _ _ _ yes no yes no yes no I would have sufficient knowledge to follow lectures if I had some extra preparation _ _ _ _ _ _ yes no yes no yes no

Language certificates (full name, date, score) _________________________________________ _________________________________________ Please provide a copy of an English certificate required by the university of your choice*! Language tests, which will be taken before the scholarship ____________________________________ Date of test _____________________________________ * Visit the website http://www.eurasia2.cz/page/application-documents/ to check the English
requirements for the university of your choice.

7. W ORK EXPERIENCE RELATED TO CURRENT STUDY Type of work experience / Name of the Institution Period Country

EURASIA 2

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8. ONLY FOR STUDENTS (INCLUDING PHD): 2 RECOM ENDATION M LETTERS OF SENIOR ACADEM ICS Please add 2 recommendation letters in a closed envelope. Title, Name of the recommending professor Institution Subject area of the professors

I certify that the information in this application is accurate. I dont have any psychical or physical diseases and disabilities, which I have not mentioned in the application and which would compromise my participation in the Erasmus Mundus Partnerships Action 2 Programme EURASIA 2 Reference: 182724-EM-1-2010-1-CZ-ERAMUNDUS-EMA21-L12. I certify that I will tell personal changes and additions immediately to the project coordinator the Czech University of Life Sciences Prague. I agree that this application and accompanying documents can be forwarded to partner Institutions, who are cooperating in this programme. I certify that I have not resided nor carried out main activity (study, work, etc.) for more than a total of 12 months over the last five years in one of the European countries.

_______________________________ Place and date

______________________________ Signature of the applicant

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CHECKLIST FOR ENCLOSURES TO BE ADDED: Please provide English translations of all the documents!

1.CV (EUROPASS see more: http://europass.cedefop.europa.eu/) 2.Application letter describing your motivation (max. 3 pages) 3.Academic transcript (an official list of courses you have attended so far, including
Grade Point Average)

4.Copy of your secondary school / high school leaving certificate or university

entrance exam results (only for students) 5.Copy of your bachelors degree or an equivalent amount of ECTS credit points (180) if you want to register for a Master programme 6.Copy of your Masters/ diploma degree if you want to register for a PhD programme 7.Copy of an English language certificate (please see your chosen universitys English requirements) + other language certificates (if any). It is also ok if language certificate is indicated on the transcript of records. 8.Copy of your passport (page with your picture) or personal ID card, if you do not have a passport (Candidates finally selected for mobility will be required to obtain an international passport before being able to travel to Europe!) 9.One passport-sized photograph 10.Copy of your student ID card (page with your picture) 11.For BSc, MSc and PhD students: two recommendation letters of senior academics 12.For Master, PhD, Post-Doc and Academic Staff: 3-page research proposal including references 13.Please see additional documents requested per European universities available on http://www.eurasia2.cz/page/application-documents/ 14.If applicable: proof of belonging to target group 3 (e.g. medical certificate or confirmation of refugee status etc) After acceptance of your application, you may be requested to have ALL TRANSLATED DOCUMENTS OFFICIALLY AUTHORISED (AND ALL DOCUMENTS CERTIFIED by Embassies/Ministries as requested by your host university) and to submit additional documents (e.g. medical certificates).

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