APPLICATION FORM

MASTER OF ENVIRONMENTAL AND ENERGY MANAGEMENT (MSC) FOR THE ACADEMIC YEAR 2012-2013

Please send a recent digital passport photo together with your application

Please print this application form. Answer each question clearly and completely (print or type), read carefully and follow all instructions. If you need more space, attach additional pages of the same size. 1. PERSONAL DETAILS Family name First name(s) Address : : :

Residence and Country : Phone number E-mail address Date of birth

(dd/mm/yyyy)

: : : : : : : : married / unmarried

Place of birth
(as written in your passport)

Country of birth Nationality Male / female Civil Status

2. EDUCATIONAL RECORD (academic education) Educational Institution 1 Major fields of study Degrees & Diplomas Years attended fromto Educational Institution 2 Major fields of study Degrees & Diplomas Years attended fromto : : : : : : : :

3. EMPLOYMENT RECORD (only if applicable) Present or most recent post Name of employer Address of employer Type of organisation : : : Private organisation Educational institution Other:

(Semi-) government (national or federal) Non Governmental Organisation International Organisation Your position Years of service (from - to) : : :

Description of your work, indicating your personal responsibilities:

4. LANGUAGE English proficiency (fair F, good G, excellent E), please choose as appropriate Read: Write: Speak: F F F G G G G E E E E

Understand: F TOEFL score : IELTS score : 5. FUNDING

If you are going to apply or if you have already applied for a scholarship, then what is the name of the organisation? Date of application: Name of contact person: Address: Organisation: Who will cover all the expenses involved, if you did not apply for a scholarship or if the scholarship for which you are going to apply, is not granted? Name: Address: Organisation:

6. VARIOUS List any significant publications written by you, giving year of publication:

How did you come to know about this programme?:

7. SIGNATURE I certify that the foregoing statements are true, complete and correct.

Date:

Signature:

This application form can be sent by post or by email. We can only accept JPEG or PDF formats when sending the application through email. Applications should reach us no later than the 1st of May 2012. Please attach the following documents: A statement that comprehensively describes the applicants motivation to participate A Curriculum Vitae that summarises your educational career and working experience Proof that you have basic knowledge of chemistry (high school level) A certified copy of a diploma that proves the required entry level for the programme (minimal Bachelors degree or equivalent in an academic field), together with the official transcript of academic records Two letters of recommendation English language test (IELTS or TOEFL) University of Twente, F.a.o. Ms. R.J. Koster or Mrs. H.G. van Meerendonk-Obinna PO Box 7658 8903 JR Leeuwarden The Netherlands Email: r.j.koster@utwente.nl