imec PhD programme /
To complete the form TAB between entry areas and click on the check boxes to mark and unmark them.
PERSONAL DATALast Name: / Click here to enter text. / First Name(s): / Click here to enter text.
Place of Birth: / Click here to enter text. / Nationality: / Click here to enter text.
Country of Birth: / Click here to enter text. / Native tongue: / Click here to enter text.
Date of Birth: / Click here to enter text. / Gender: / ☐ Male ☐ Female
Permanent Address:
(where you have permanent, legal residence)
/ Present Address: (valid till Click here to enter text. )
(if different from your Permanent Address)
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Telephone Number: / Click here to enter text. / Mobile Phone: / Click here to enter text.
Email Address: / Click here to enter text.
ADMINISTRATIVE DATA (relevant in case of acceptance to the program)
Civil status: ☐ Single ☐ Married ☐ Legal cohabitating
Do you intend to marry before you come to imec? / ☐ Yes ☐ No
Will your partner and/or child(ren) join you? / ☐ Yes ☐ No
EDUCATION
Please give details of your academic qualifications including any current studies, listing your undergraduate studies first.
ACADEMIC DATADates
From (dd/mm/yy) to (dd/mm/yy) / Name and location of University/College / Main subject of studies / Language of instruction / Qualification
(e.g. BSc/MSc) / Grade/
Result
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Please provide evidence of your academic qualifications by sending in your Bachelor and Master certificates and transcripts/grades. The transcripts should show all courses taken separately, the marks obtained and the maximum and minimum-passing marks.
A rank in class grade point average or percentage should also be given.
List the documents you enclose with your application.
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If you have not completed your Master programme at the time you submit your PhD application, then you are requested to include your examination results available at the time of submission.
If the transcripts and certificates are not in Dutch, French, German of English, a translation in one of the mentioned languages must be added.
The certificates and transcripts must be authenticated by an authority of your country or by the educational institution that issued the documents.
TRACK RECORD
List your honors, scholarships and grants, rewards and/or publications, relevant for your application:
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Your teaching or professional experience including summer and term-time work. Give the name of the employer, dates and nature of work:
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Other experience, including military, volunteer work, travel. Give dates and nature of experience:
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Your extracurricular activities and accomplishments:
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If the duration of your studies took longer than expected, clarify the reason for this:
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If there is a gap of more than 6 months between your MS graduation date and your PhD application at imec, motivate the reason for this:
☐ / Military service☐ / Travel
☐ / Industrial experience
☐ / Started PhD elsewhere
☐ / Other, please specify: Click here to enter text.
List the languages you know and indicate your proficiency by marking the appropriate spaces:
LANGUAGE PROFICIENCYClick here to enter text. / Mother tongue
Speaking / Writing / Reading / Listening
Language / Very good / Good / Fair / Very good / Good / Fair / Very good / Good / Fair / Very good / Good / Fair
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Was all or part of your education in English? ☐ Yes ☐ No
If so, which part? Click here to enter text.
How many years? Click here to enter text.
TEST RESULTS
Please read the general information on our webpage to determine which test results you need to provide.
Note: Imec does not have an institutional code as we don’t need official score reports from ETS.
Please, send in a scan of your test results sheet, along with your application documents.
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TOEFL
/ Test date / Reading / Listening / Speaking / Writing / Total Score
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IELTS / Test date / Listening / Reading / Writing / Speaking / Total Score
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Cambridge
ESOL Test
/ Test date / Grade
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APPLICATION INFORMATION
Have you previously applied for admission to imec? ☐ Yes ☐ No
If yes, for which programme?
☐ Master internship programme
☐ PhD programme When: Click here to enter text.
☐ Job application
How did you learn about the imec doctoral programme?
☐ I am/was an internship/thesis student at imec
☐ I am/was a KU Leuven student
☐ Internet search
☐ Poster/publication/conference
☐ Advertisement
☐ Referred by colleague/friend/professor/supervisor
☐ Other, please specify: Click here to enter text.
Referring to the topics listed on our website, make a list of subjects of your choice. List them by priority and limit to 3. Do not forget to mention the reference code for each topic you select.
Motivate for each project separately why you believe to be a suitable candidate, in maximum 5 lines.
1. Ref. code: Click here to enter text.
Topic title: Click here to enter text.
Motivation: Click here to enter text.
2. Ref. code: Click here to enter text.
Topic title: Click here to enter text.
Motivation: Click here to enter text.
3. Ref. code: Click here to enter text.
Topic title: Click here to enter text.
Motivation: Click here to enter text.
Any additional information you would like to share:
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I declare, upon my honor, that this information is true, complete and accurate.
Date: Click here to enter a date. Signature: Click here to enter text.
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