Erasmus Mundus Master Program with Scholarship - MITRA

Application Form (2012-2014)

Erasmus Mundus Master Program with Scholarship - MITRA

- Western Balkans (Albania, Bosnia and Herzegovina, Croatia, the Former Yugoslav Republic of Macedonia, Montenegro, Serbia and Kosovo under UNSC Resolution 1244/99)

- Turkey

- Tunisia and Egypt

- Eastern Neighbourhood countries (Armenia, Azerbaijan, Belarus, Georgia, Moldova and Ukraine)

PERSONAL DETAILS

Civility:
Name:

First Name:
Date of Birth:
Place of Birth:
Country of Birth:
Nationality:
Gender:
Marital status:
Number of children:

CONTACT INFORMATION

Address for correspondence

Street, number:
P.O. Box:
City:
State:
Country:
Postal Code:
Telephone country code:
Phone Number:
Mobile Phone:
Fax Number:

Permanent address

Street, number:
P.O. Box:
City:
State:
Country:
Postal Code:
Telephone country code:
Phone Number:
Mobile Phone:
Fax Number:

ACADEMIC QUALIFICATIONS

Undergraduate Degree(s) or first degree(s)

Type of degree:
Name of institution:
Field:
Date of graduation:
Date of attendance:
Major:
Minor:
Date attendance 2:

(Post)-Graduate Degree(s)

Type of degree:
Name of institution:
Field:
Specialization:
Date of graduation:

Current Situation

Are you currently enrolled in a (non-) degree course or education training relevant to your application? Yes No

Please describe any courses/studies you have attended recently, including dates and brief description:

PROFESSIONAL QUALIFICATIONS

Employmentinformation

LANGUAGE PROFICIENCY

English language proficiency

Have you studied in an English-speaking country?
When (Year)?
How long? (month):

Where:

French language proficiency

Have you studied in a French-speaking country?
When (Year):
How long? (month):
Where:

Native Language

What is your native language?

Other languages

REFERENCES

First Reference

First Name:
Last Name:
University / Organisation:
Position:
Professional Address:
City:
Country:
Email:
Fax number:
Telephone country code:
Telephone:

Second Reference

First Name:
Last Name:
University / Organisation:
Position:
Professional Address:
City:
Country:
Email:
Fax number:
Telephone country code:
Telephone:

Optional Reference

First Name:
Last Name:
Organisation:
Position:
Address:
City:
Country:
Email:
Telephone country code:
Telephone:

MOBILITY SCHEME

Initial Tracks

Track 1 - Crises, Conflits, Société civile

Track 2 - Le Sujet migrant: récits et pratiques sociales

Track 3 - Territoires et mobilités: approche comparative.

Choice n°1:
Choice n°2:
Choice n°3:

Thesis Proposal

Title:
Brief description:

FUNDING

Funding

Funding available:
Kind of funding:
I would like to apply for an Erasmus Mundus action 1 scholarship:
Scholarship category:

Financial resources

Family contribution (€):
Loans (€):
Student's own contribution (€):
Expected (summer) earnings (€):
Sponsorships (€):
Name of sponsor (if applicable):
Otherresources (€):
Total resources(€):

SURVEY

How you initially learned about our courses?:
Please specify:

I, ______hereby certify that theinformationsubmitted on this form is true and accurate

Signature:

Please send this application form as well as the following required documents to , before 12th February 2012.

- Photo
- Passport or ID card
- Currivulum Vitae
- Motivation letter
- Bachelor degree
- Academic transcript
- Draft of Master thesis proposal (related to MITRA or to one of the specialities)
- English proficiency certificate
- French proficiency certificate
- Two reference letters