PhD Program in Chemistry University of Siegen
Application Form
APPLICATION FORM University of Siegen Germany
PhD Program
A) INFORMATION ON STUDENT
Family Name: .........................................................................................
First Name(s): ........................................................................................
Maiden (Birth) Name if applies: ..............................................................
Date of Birth: ..........................................................................................
Place of Birth (both, City and Country): .................................................
Citizenship (Nationality): .........................................................................
Sex: male/female: …………………….
Permanent address: ...............................................................................
Mailing address: .....................................................................................
Telephone: ........................
Fax: ...................................
E-mail: ....................................................................
B) EDUCATION
B1) School, High school
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From ............ to ............ Institution …………. Average grade(s)/max. grade(s): ……
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B2) University
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Name of Institution, Department, with complete address (in English):
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Date of first entrance to a University: ............. Present/last study year: ...................
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Academic degree(s) already awarded or in view at Home Institution: .......................
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2 Academic contact persons (name, academic degree, phone, fax, e-mail): ………..
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PhD Program in Chemistry University of Siegen
Application Form
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B3) Previously completed studies, and grades achieved
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Degree(s) already obtained with names(s) of institution(s), study dates (from, to, year/month) and
average grade(s)/max. grade(s):
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B4) Special honours and awards (including extracurricular activities)
B5) Knowledge of languages
B6) Knowledge of computers
B7) Interest and hobbies
B8) Research Interests: (Important to direct your application to the appropriate person! Please refer to the
department internet pages http://www.uni-siegen.de/dept/fb08/ to find suitable research groups and areas.)
C) FINANCIAL SUPPORT
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Way of financing (grant, scholarship, privately): ..............................................
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Name of fund Institution: .............................................................................
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Request of funding from Department of Chemistry: ........................................
D) LIST OF ATTACHED DOCUMENTS
Certified copies of original documents accompanied by an English or German translation (please tick box where
appropriate)
High school diploma
Record of university degrees (master, bachelor, intermediate or final exams)
List of courses taken (title, number of hours, grades with grading scale)
Proof of English language proficiency (TOEFL, Cambridge Certificate or comparable) or German
language proficiency
Two letters of recommendation from academic teachers, which includes statement indicating the
students performance and his ranking, such as "among the top 10%, top 10-20%")
Curriculum vitae
Certified transcripts of your academic records (at least a M.Sc. is required)
E) SIGNATURE OF STUDENT (With place and date)