Application Form for Scholarship under cLINK Project (EU EACEA 42/11) Program Applied for: Teachers Training Please explore cLINK site (www.clink-edu.eu) before you fill this form Nationality: Your preferred EU Universities 1. (priority basis): 2. 3. Insert colored photograph (passport size) in jpeg format (with shortest possible size) Personal Information Full Name (IN BLOCK LETTER) Contact Address Date of Birth Gender Passport Number (if any) Email Address Skype ID (if any) Mobile Contact Number (with country code) Have you stayed 12 months or more in any EU countries? If yes where and the purpose of your stay Current Status and Institution Research area with four keywords: Name of the Institution you are currently working as a faculty: Key Teaching Area (Name of subjects/ modules you teach): Language used for Teaching: Present position: Expire Date Present Job description: Past Academic result - PhD(Institution attended, GPA/ Class, Grade points or marks in major subject/ Thesis)* Masters (Institution attended, GPA/ Class, Grade points or marks in major subjects/Thesis)* - Title of Masters Project or Thesis (if applicable) Undergraduate/ tertiary level (Institution attended, GPA / Class, Grade points or marks in major subjects)* - Title of Undergraduate Project or Thesis (if applicable) College Final/ HSC/ A Level/ Equivalent Exam (Institution attended, GPA/Class, Grade points or marks in major subjects)* - School Final/ O level/ SSC/ GCSE/ Equivalent Exam (Institution attended, GPA/Class, Grade points or marks in major subjects)* Language Proficiency (English/ French/ German/ others) IELTS/TOEFL score (if available)* Other Language test scores (if any) Scholarship: Give a list of scholarships you have obtained for your academic performance. Research Publications in Last Five Years: Only include last five years publications published in international workshops/conferences and in international journals (if any). Other Achievements: List any other achievements other than academic ones. Extra Curricular Activities: List extra-curricular and voluntary/social activities in which you think your contribution is significant. Social Status/Vulnerability: Please mention succinctly (with proof) if you have any sorts of physically challenged situation or you have come from a minority ethnic/ indigenous group. ActivityPlan: Provide your activity plan at EU University (max 10 sentences) DECLARATIONS I hereby attest that if I am nominated for scholarship under cLINK project, I will be bound by the rules and regulations of the conditions set forth in the offer I also attest that if I falsify/ withhold any information requested in this application form, I will not be eligible for any scholarship I allow cLINK authority to verify the authenticity of the above information by contacting the institutions referred by me in the application. Signature of the Applicant Date: * ** Please add evidences at the end of the application Please provide supporting papers (mark sheets, language test score etc.) N.B: After this page (scan and add supporting papers and prepare a single pdf file)