CONFIDENTAL

CONFIDENTAL

FELLOWSHIP APPLICATION FORM FOR DIPLOMA/MASTER COURSES IN NORWAY

Please

attach a

recent

passport

photograph

NORAD Fellowship Programme

NORAD- Norwegian Agency for Development Cooperation

This application form with required enclosures, should be

submitted to a Royal Norwegian Embassy or Consulate for

transmission to SIU, Norway. Cf. section 12 below and

section 7 in the Course Catalogue.

Photo taken in ......... (year)

1) PERSONAL INFORMATION

(Please give names and information exactly as they appear in your passport. Please use capital letters)

Surname

……………………………………………………………………………………………

Given name

……………………………………………………………………………………………

Middle name(s)

…………………………………………………………………………………………

Please of birth

…………………………………………

Nationality

………………………………

Date of birth (dd/mm/yy) : ………………………

Age

………………………………

Gender :

male

female

single

married

Name of spouse

………………………………… Number of childern: ………………………

Present address of correspondance : ……………………………………………………………

……………………………………………………………………………………………………………

Telephone : …………………………………… E-mail : ………………………………

Name and address of person to be notified in case of emergency :

………………………………………………………………………………………………

Telephone : ……………………………………… Fax : ……………………………

2) APPLICATION FOR COURSE AND UNIVERSITY (As given in course catalogue and restricted to one course)

Name of Diploma / Master Course	:	……………………………………………………………………………………
Name of University	:	…………………………………………………………………………………………………………

3) EMPLOYER : (Name and address of your organisation / company)

…………………………………………………………………………………………………………………

………………………………………………………………………………………………………………

Telephone : ………………………… Fax : ……………………… E-mail : …………………

4) EDUCATIONAL RECORD (start with institution most recently attended and work backward)

Educational Institutional	Location :	Major field of study	Degrees and diplomas	Years attended
Educational Institutional	Location :	Major field of study	Degrees and diplomas	from	To

5a) EMPLOYMENT RECORD

It is important to give complete information. For each area you have completed please give details of your details and responsibilities :

Name of company :	Title of your position :	Rasponsibilities :	Date :
			From	To

5b) Exact description of duties and responsibilities in your present position :
……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………

6) PUBLICATIONS Please attach a list of publications you have written (if any) including the title of thesis :

……………………………………………………………………………………………………………………

7) MOTIVATION

What relevanse do you think your studies will have on the conbditions in your profesional field and the responsibilities you expect to resume in your home country ?

……………………………………………………………………………………………………………………

8) ENGLISH LANGUAGE COMPETENCE

(please fill in appropriate box)

Reading skills

fair

good

very good

Writing skill

fair

good

very good

For countries where English is not the native language, a TOEFL test certificate or an equivalent diploma is require. Please note that a score of 500 points (paper – based) or 170 (computer – based) is the minimum required to accep your application.

Where and how did you learn English? Specify institution, level and dates of attendance .

Please enclose official dokumentation (See section 12).

……………………………………………………………………………………………………………………

9) FOREIGN EXPERIENCE

Please indicate dates and duration of your stay in countries other than your own :

Cuontry :

Duration of stay (list only those of three months or more) :

Purpose of stay :

10) PREVIOUS SCHOLARSHIP (S)

……………………………………………………………………………………………………………………

11) PROFESSIONAL INTERESTS AND CARRER OBJECTIVES

……………………………………………………………………………………………………………………

12) SUBMISSION

Please submit this application whit all the required documents as specified below :

a)	Certified transcripts/lists of grades of examination records and certificates and copies of your Diplomas. These documents must be provided in English
b)	TOEFL or IELTS Certificate of proficiency in English
c)	Recently issued medical certificate of proficiency in English
d)	Leave of absence letter from your employer
e)	Short presentation of the organisation / institution in which you are employed
f)	Copies of your passport (or an official identification card issued from your government authorities) with your present name
YOUR APPLICATION WILL NOT BE CONSIDERED WITHOUT THESE DOCUMENTS

13) I understand that I am required to return to my country at the end of my followship stay in Norway .
………………………	………………………	………………………
Place	Date	Signature (Applicant)
14) This applicant have been granted leave of absence from his / her job if he / she receive Letter of Award.
………………………	………………………	………………………
Place	Date	Signature (Applicant)