Application form for UREKA DiaMonD Programme 2011

Section 1: Personal Details

 

First Name
Surname
Current address:
Permanent address:

 

e-mail address

Home telephone

 

Nationality

Date of Birth

Male/ Female

 

 

Section 2: Education

Current course title and code:
Year of study:
Institution and address:

 

Student number

 

 

Examinations

List all courses/modules taken for each year and grades/marks recieved

 
Honours/Awards/Achievements:
Other relevant experience e.g. work experience etc.:

Section 3: Essay

Describe your interest in participating in this programme (approximately 400-500 words).

Write a short note on what you intend to do after you have finished your degree.

 

 

How did you hear about the DiaMonD UREKA programme?

Section 4: Projects

Please list three projects you would like to apply for in order of preference

Section 5: Referees

Please give names, addresses, telephone numbers and e-mail addresses of two academic referees who are willing to provide you with a letter of recommendation. We will contact the referees ourselves, letters of recommendation are NOT required at this stage.

Referee 1:

Referee 2:

Section 6: Curriculum Vitae (CV)

Please paste your CV here

 

Section 7: This section is optional

The question below is asked in order to assess the extent to which students from all backgrounds are participating in research careers. As with all other information in the form, the information provided will be treated confidentially.

Please indicate if someone in your immediate family (e.g. sibling(s) parent(s)/guardian(s), etc.) has attended university.

YES/NO

If YES, please indicate to what level (PhD, degree, Diploma) and your relationship with the family member (brother, mother, etc.)

 

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