University of Science and Technology of Hanoi
Trường Đại Học Khoa Học và Công Nghệ Hà Nội
Vietnam France University
APPLICATION FORM
FOR MASTER WATER – ENVIRONMENT - OCEANOGRAPHY
This form shall only be completed electronically
FOR USTH USE ONLY
Status of Application
Application No.:
Accepted
Rejected
Pending
Date of Receipt:
______________(dd/mm/yyyy)
Received by:
________________________
Note:
_________________________________________
_________________________________________
_________________________________________
Admission’s stamp and signature
PART 1: PERSONAL INFORMATION
Have you previously applied for a program at USTH?
Yes
No
Student ID: ___________________________
Photo
3x4
Title Mr, Mrs,Ms
Last Name
Middle Name
First Name
Nationality
Date of Birth (dd/mm/yyyy)
/
Place of Birth
/
ID (for Vietnamese citizens) or Passport Number (for international student only): _______________________________
Expiry Date (dd/mm/yyyy): ___________________
Please attach a copy of your Passport and Visa to this Application Form (for foreign students only)
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PART 2: CONTACT INFORMATION
2.1. Permanent Address
Number, Street Name
District Click here
Click here to enter text.
Province/State
to enter text.
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to enter
text.
Town/City
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enter text.
Country
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enter text.
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enter text.
Country
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enter text.
2.2. Postal Address (only if different from Permanent Home Address)
Number, Street Name
District
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enter text.
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Province/State
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to enter
text.
Town/City
2.3. Contact Details
Telephone:Click here to enter text.
Mobile:Click here to enter text.
Email: Click here to enter text.
2.4. Emergency Contact Person
Full name: Click here to enter text.
Relationship:Click here to enter text.
Mobile: Click here to enter text.
Email: Click here to enter text.
PART 3: APPLICATION INFORMATION
Master Water, Environment and Oceanography
Program for Research Master
Program for Professional Master
(This program will be taught during day time in week
(This program will be taught in the evenings of week days
days. Internships in laboratories )
and at weekends. Internships in companies)
Water Pollution and Treatment
Intake 2015 – 2017
Biogeochemical and Ecological
Processes
Year 1 (M1)
Oceanography and
Hydrology
Year 2 (M2)
For the academic year 2015-2016: Have you already applied or do you intend to apply for other courses in Vietnam or abroad?
If yes, please indicate the name of the course and host: …………………………………………………………………………………………..
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PART 4: ACADEMIC HISTORY
4.1. Academic Qualification
QualificationClick here to enter text.
InstitutionClick here to enter text.
Country: Click here to
enter text.
Duration:Click here to enter text.
Start Date
(year/s)
(month/year)
Click here to
enter text.
Completion Date Click here to enter
(month/year)
Full time
text.
Part time
Successful completion of program
(If YES, please provide certified copies)
Yes
No
GPA: ……
Have you completed another course? If yes, please indicate:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Have you received exceptionally high grades, awards, prizes?
Name and Date (dd/mm/yyyy):
____________________________________________________________________________________________________
____________________________________________________________________________________________________
4.2. Language Skills
Your level of competence in foreign languages. Please provide test results if available (ex: IELTS; TOELF; TOEIC; DELF…)
Advanced
English
French
Click here
to enter
text.
Click here
to enter
text.
Intermediate
Beginner
None
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enter text.
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enter text.
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enter text.
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enter text.
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enter text.
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enter text.
Test results
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4.3. Fellowships
Were you supported by a grant?
Yes
No
According to which criteria was the grant
awarded?
Merit
Financial situation
Others
………………………….
Please indicate the amount of the grant (fees, living expenses):_______________________________________________________________
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PART 5: EMPLOYMENT OR RESEARCH INFORMATION (OPTIONAL)
5.1. Relevant Employment and Research History
(For the students who wish to declare their work or research experiences after Bachelor Degree)
From: Click here to enter
To: Click here to
(mm/yyyy)
text.
Position: Click here to enter text.
(mm/yyyy)
enter text.
Duties: Click here to enter text.
Company/Employer/Labs:
Country:Click here to enter
Click here to enter text.
text.
From: Click here to enter
(mm/yyyy)
text.
To: Click here to
Position: Click here to enter text.
(mm/yyyy)
enter text.
Duties: Click here to enter text.
Company/Employer/Labs:
Country: Click here to enter
Click here to enter text.
text.
Research activities: please indicate what field did you work on?
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
5.2. Relevant Memberships and/or Affiliations
(Included trade or professional organizations)
Organization: Click here to enter text.
Your status:Click here to enter text.
Organization: Click here to enter text.
Your status: Click here to enter text.
PART 6: CERTIFICATION OF ACCURACY
I certify that the information contained in this application is accurate and complete. I will notify USTH immediately of any
change in my personal details.
I acknowledge that USTH has the right to refuse admission or to cancel student scholarships in case of false statement or
omission of significant information.
I acknowledge that I will have to provide original proofs of my qualifications and any other documents as requested in this
form.
Signature and full name:Click
Date (dd/mm/yyyy) :Click
here to enter text.
here to enter text.
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PART 7: USTH CONTACT INFORMATION
Application file is to be mailed to: admission-weo@usth.edu.vn
Address: Room 805, 8th floor, Training and Services Building (Tòa nhà Đào tạo và Dịch vụ),
18 Hoang Quoc Viet, Cau Giay, Ha Noi
Contact Person:
Ms. Nguyen Thi Hong Lien
Assistant to WEO Department
Tel: + 84 (0) 4 37 91 77 47
Application Deadline:
1st
Wave: June 15th, 2015
2nd Wave: August 30th, 2015
Incomplete applications will not be considered
PART 8: APPLICATION CHECKLIST
8.1. Mandatory Documents:
Motivation Letter in English (outlining why you would like to enroll in USTH);
Application Form (in English);
Bachelor Degree and University Transcript (certified English translation);
Recommendation Letters (from your teachers, employers, etc).
8.2. Optional Documents:
Certificate of Foreign Languages (English, French)
Certificate of Achievements
Others (publications, etc.)
Important note:
For those who cannot present the BA degree or formal academic transcript, the enrollment can be based on the provisional letter of
graduating confirmation or academic transcript. Successful candidates are required to provide all mandatory documents to confirm
enrollment.
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