PhD Program in Cancer and Immunology
APPLICATION(Please, fill in with the name of the thesis director you have chosen from the list provided on our website: http://www.unil.ch/cancer-immunology. You should indicate 3 choices, if possible:
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Personal Information
1. / m Mr m Ms
2. Legal family name / ……………………………………………………………………………………………………………..
3. Legal first name(s) / ……………………………………………………………………………………………………………..
4. Country of citizenship / ……………………………………………………………………………………………………………..
If you are not a Swiss citizen, do you have a Swiss residence permit? / m Yes m No
If yes, type of permit / m A m B m C
Date of birth (DD/MM/YYYY) / …………………………………………………………………
5. Place of birth (for Swiss citizens, place of citizenship) / …………………………………………………………………
6. Marital status m Single m Married m Divorced children (Nbr): / ……………..
Address where we can permanently reach you (e.g. your parents' address)
Family name / ……………………………………………………………………………..
First name / ……………………………………………………………………………..
Street / ………………………………………………………………………………………………………
Additional information (residence, …) / ………………………………………………………………………………………………………
Town / …………………………………………………………………………………………………….
Postal code / ……………………………………
Region / ……………………………………………………………………………..
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Tel (with international code) / ……………………………………………………………………………..
Fax (with international code) / ……………………………………………………………………………..
Email address / ……………………………………………………………………………..
Your current address, if not identical to your permanent address
Street number / ……………………………………
Additional information (residence, …) / ………………………………………………………………………………………………………
PO Box / ……………………………………
Postal code / ……………………………………
Town / ……………………………………………………………………………..
Region / ……………………………………………………………………………..
Country / ……………………………………………………………………………..
Tel (with international code) / ……………………………………………………………………………..
Fax (with international code) / ……………………………………………………………………………..
Email address / ……………………………………………………………………………..
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PhD Program in Cancer and Immunology / Application form Fall Session / Page de 9PhD Program in Cancer and Immunology
Academic and Work Experiences7. List all universities, colleges or other academic institutions attended since high school. Do not abbreviate names of institutions. Include in your application certified transcripts listing courses and all your grades for all studies at these academic institutions. These transcripts must be translated into English if not originally in French, German, Italian or English. Start from the most recent diploma
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Institution name and location / Major field of study / Dates attended / Duration of study*
/ Date** / Degree**
from / to
* towards this degree, full time and with no failures or interruptions ** Conferred or expected
Academic and Work Experiences10. List all universities, colleges or other academic institutions attended since high school. Do not abbreviate names of institutions. Include in your application certified transcripts listing courses and all your grades for all studies at these academic institutions. These transcripts must be translated into English if not originally in French, German, Italian or English.
Institution name and location / Major field of study / Dates attended / Duration of study*
/ Date** / Degree**
from / to
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PhD Program in Cancer and Immunology / Application form Fall Session / Page de 9PhD Program in Cancer and Immunology
List occupations, other than as a student, in which you have engaged to any considerable extent, giving names and location of employers and dates of employment. Include military service and any teaching or voluntary work experience you have had.Occupation / responsibility / Employer / location / Time period
11. List publications (books, articles, short reports, …) or inventions you have patented
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12. List academic honours, prizes and fellowships you have received
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PhD Program in Cancer and Immunology
Languages13. List all languages you know and your level in written and oral expression
Written / Oral
English / m poor m fair m fluent / m poor m fair m fluent
French / m poor m fair m fluent / m poor m fair m fluent
m poor m fair m fluent / m poor m fair m fluent
m poor m fair m fluent / m poor m fair m fluent
m poor m fair m fluent / m poor m fair m fluent
14. List language of instruction in
Primary school / ……………………………………. / Secondary school / …………………………………….
University / ……………………………………. / Graduate school / …………………………………….
15. Indicate here your TOEFL and GRE scores and provide copies of records if available (not mandatory, but highly recommended for students who have not followed more than three years of study in French or English)
TOEFL / ……………………………….
GRE / verbal / …………… / quantitative / …………… / analytical / ……………
Alternative test(s) / certificate (s) of English or French proficiency
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PhD Program in Cancer and Immunology
Your Referees16. List of 3 referees (it is mandatory)
1. Name / …………………………………………………………………………………………………………………………
Address / …………………………………………………………………………………………………………………………
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Tel & Email: / …………………………………………………………………………………………………………………………
In the capacity of / …………………………………………………………………………………………………………………………
2. Name / …………………………………………………………………………………………………………………………
Address / …………………………………………………………………………………………………………………………
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Tel & Email: / …………………………………………………………………………………………………………………………
In the capacity of / …………………………………………………………………………………………………………………………
3. Name / …………………………………………………………………………………………………………………………
Address / …………………………………………………………………………………………………………………………
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Tel & Email / …………………………………………………………………………………………………………………………
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PhD Program in Cancer and Immunology
Statement of objectivesPlease list here your main subjects of scientific interest (present and future) and potential hosting laboratories. Include as far as you can your particular interests, be they experimental, theoretical or issue-oriented, and show how your background and our programme support these interests (1 page max.).
Certification Sheet
I certify that I have read all the instructions and that information in this application is true and complete. I understand that misrepresentation may be a cause for cancelling my admission or appointment. I understand that all credentials and documents I submit become the property of the Faculty of Biology and Medicine, UNIL, Lausanne.
Place/date / Signature
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Please send by regular mail OR BY EMAIL your complete application, without binding or staples, to :
Mrs Françoise Flejszman
PhD Program in Cancer and Immunology
Administration Office
Department of Biochemistry, fUNIL
chemin des Boveresses 155
CH-1066 Epalinges, Switzerland
Enclosures
(please check that application is complete before mailing) / · The application form
· Copy of your high school diploma and grades
· Copies of your official transcripts of diplomas and grades from all academic institutions of higher education you have attended and their translations into English if not originally in French, German, Italian or English
· Copy of GRE or TOEFL (or other certificates of language proficiency) if applicable (not mandatory)
· Curriculum Vitae
· Three letters of recommendatioN signed by your referees
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