Ref.

no: 2007000495
Ethiopia

CHALMERS INTERNATIONAL MASTER PROGRAMME Application form

Programme(s) applied to:
1st priority: 2nd priority: STRUCTURAL ENGINEERING AND BUILD. PERF. DESIGN GEO AND WATER ENGINEERING

Personal details:
Date of birth: Gender: Family name: First name(s): E-mail address: Phone number: C/O Address: Address: Zip code: City: Country: 1975-03-04 Male Jaleta Abera Mamo coongee@yahoo.com 251-0911-83-99-37 Adama university East Showa P.O.BOX 1888 Adama Ethiopia

Academic background
First university degree
Original name of university or higher education: Name of university in English: Campus: Address of university: Country: Phone number: Fax: Official web site of the university (URL address): Student number (if available): Date of registration: Duration of full programme: Date of awarded degree: Date of expected degree: Name of degree / Diploma awarded: Rank in class (if officially stated): English translation of degree / Diploma awarded: Major subject: Title of thesis / Diploma project (if applicable): Accumulated GPA (all courses) Sum of grades in all courses (g): Number of courses (n): GPA: Total possible GPA of Programme Minimum for passing: Maximum: 2 4 2977 32 93,03 Adama University(Nazareth college of TTE) Adama University(Nazareth college of TTE) Adama campus Adama University, P.O.BOX 1888 Adama Ethiopia 251-0221-11-04-00 0251-2-110480 ntc@ethionet.et EXC/32/95 2000-09-30 5 2005-07-09 Bachelor of science in construction technology 0 Bachelor of science in construction technology construction technology Structural Design of G+4 mixid use building

Second university degree

Original name of university or higher education: Name of university in English: Campus: Address of university: Country: Phone number: Fax: Official web site of the university: Student number (if available): Date of registration: Duration of full programme: Date of awarded degree: Date of expected degree: Name of degree / Diploma awarded: Rank in class (if officially stated): English translation of degree / Diploma awarded: Major subject: Title of thesis / Diploma project (if applicable): Accumulated GPA (all courses) Sum of grades in all courses (g): Number of courses (n): GPA: Total possible GPA of Programme Minimum for passing: Maximum: 2 4 Yes Yes 3054 35 87,26 Bahirdar university(Bahirdar polythechnic institut Bahirdar university(Bahirdar polythechnic institut Bahir dar cumpas Bahi dar university, P.O.BOX 079 Bahirdar Ethiopia 251-(8)-20-59-34 251-(8)-20-20-25 www.bdu.telecom.net.et R/005/87 1995-09-30 0 1997-07-05 Advanced depoloma in wood technology 0 Advanced depoloma in wood technology wood technology

My application package is complete. I approve that Chalmers saves provided information in a database. (The information is used for the admission process and for statistical information. Only Chalmers officials have access to this database.)

Applicant's signature
I hereby certify that all information given in this form is correct and complete.

Date and place

Applicants signature

Send the application package (enclose the printed and signed application form with the required documents listed on the web site www.chalmers.se/masters.html) by regular post. This package must have reached Chalmers by January 31 (in year of enrolment). The application is regarded as complete and valid only when Chalmers receives the printed application form and the documents verifying formal qualifications of general and specific eligibility.

Send to:
CHALMERS ULRIKSFORS NR:410 SE-833 93 STRMSUND SWEDEN

Supplementary documents
Always print and enclose an end paper when sending supplementary documents. Copies of documents that cannot be issued until after January 15 may be sent after your main application package, but they must have reached Chalmers by March 15. Applications that are not complete March 15 will not be further processed.