Application Form Ph.D. Project in CHEPS
Ms
Mrs
Family Name /
Surname
First name(s)
Mr
<Family Name / Surname>
<First name(s)>
Date of Birth
(dd/mm/yyyy)
<Date of Birth (dd/mm/yyyy)>
Nationality
<Nationality>
Permanent Address
Mail
Phone
<Mail>
<Phone>
<Fax>
Fax
Mobile phone
<Mobile phone>
E-mail
<E-mail>
Personal website
<Personal website>
Ph.D. Application Form
Contact Address
(if different from permanent address):
Mail
<Mail>
Present Occupation
Present employer and post held, if applicable
<Present employer and post held, if applicable>
University Qualifications Achieved/Expected
Please attach official transcripts of academic record (photo copies of degree certificates,
professional certificates, etc., please add Diploma Supplement if available)
(1) University/Institution attended:
<University/Institution attended>
Degree Title:
<Degree Title>
Class or Grade:
<Class or Grade>
Year of Award:
<Year of Award>
Dates of Attendance
Start date:
<Start date>
End date:
<End date>
Major subject(s):
<Major Subject(s)>
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Ph.D. Application Form
(2) University/Institution attended:
<University/Institution attended>
Degree Title:
<Degree Title>
Class or Grade:
<Class or Grade>
Year of Award:
<Year of Award>
Dates of Attendance
Start date:
<Start date>
End date:
<End date>
Major subject(s):
<Major subject(s)>
Other Professional Qualifications
Please, include here details of additional professional or other qualifications you have taken since
leaving University. Please include type of qualification, subject, grade and date. You may continue
on a separate sheet if necessary.
<Please, include here details of additional professional or other qualifications you have taken since
leaving University. Please include type of qualification, subject, grade and date. You may continue on
a separate sheet if necessary>
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Ph.D. Application Form
Language Qualifications
What is your first language?
Dutch
English
Other, please specify:
<Other, please specify>
If English is not your first language, what is your proficiency in English?
[please choose]
Please give details of your English Language qualifications, including grade, class, awarding body
and date awarded or expected.
<Please give details of your English Language qualifications, including grade, class, awarding body
and date awarded or expected>
Other Relevant Skills and Experience
Please give details of other relevant skills and experience, for example, full-time employment,
teaching or research experience, information technology skills.
<Please give details of other relevant skills and experience, for example, full-time employment,
teaching or research experience, information technology skills>
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Ph.D. Application Form
Referees
Please give the following details of two persons whom you have approached for references.
(1) Name:
<Name>
Position:
<Position>
Name of Institution:
<Name of Institution>
Mail address:
<Mail address>
Country:
<Country>
Fax:
<Fax>
Email:
<Email>
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Ph.D. Application Form
(2) Name:
<Name>
Position:
<Position>
Name of Institution:
<Name of Institution>
Mail address:
<Mail address>
Country:
<Country>
Fax:
<Fax>
Email:
<Email>
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Ph.D. Application Form
Personal Statement (optional)
Please explain your motivation to ursue a Ph.D. at CHEPS and how it relates to your
career/academic objectives.
<Please explain your motivation to pursue a Ph.D. at CHEPS and how it relates to your
career/academic objectives>
Proposed Research Area
Please attach a brief outline (e.g. 2 to 3 pages) of your proposed research topic or interests.
The proposal should make clear which topic you would like to address (research problem), why this
is relevant (scientifically and/or socially), theoretical orientations, and how you would address the
research problem (research design: is it mainly an empirical or a conceptual study; where do you
expect to find data; are you aiming for experimental, quantitative or qualitative approaches?).
Please add a list of your publications, relevant for your proposal. (You may include unpublished
theses, if desired.)
I certify that I have completed this application form myself, and that all the information I have given
is correct. I agree to CHEPS processing personal data contained in this form, or other data that
CHEPS may obtain from me or from other sources for any purpose directly connected with my
application.
Signature of Applicant
<Signature of Applicant>
Place
<Place>
Date
<Date>
Please return this form to:
Don Westerheijden
CHEPS, University of Twente
P.O. Box 217
7500 AE Enschede
Fax number: +31 53 434 03 92
Email: d.f.westerheijden@utwente.nl
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