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ΤΕΧΝΟΛΟΓΙΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΚΥΠΡΟΥ

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ΤΕΧΝΟΛΟΓΙΚΟ ΠΑΝΕΠΙΣΤΗΜΙΟ ΚΥΠΡΟΥ Powered By Docstoc
					CYPRUS UNIVERSITY OF TECHNOLOGY
SERVICE FOR ACADEMIC AFFAIRS AND STUDENT WELFARE
Student Services and Information Centre in Limassol

Andreas Themistokleous Building (Old Land Registry House)
Tel: 25 002710/11, 25 002534 Fax: 25 00 2760

Student Services and Information Centre in Nicosia                                              For Official Use Only
                                                                                 Comments of Postgraduate Studies Office to the Institute:
Siakolio Educational Centre                                                      …………………………………………………………………………
(New General Hospital), Nicosia                                                 …………………………………………………………………………….
Tel: 22001619                                                                   …………………………………………………………………………….
http://www.cut.ac.cy/studies E-mail: graduate@cut.ac.cy                         ……………………………………………………………………………
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APPLICATION FORM                                                                ……………………………………………………………………………..
(POSTGRADUATE STUDΙES)
ACADEMIC YEAR 2012-2013

     Instructions :

     This Postgraduate Student’s Application Form must be completed by Candidates who wish to apply for Postgraduate Studies to the
     Cyprus International Institute in association with Harvard School of Public Health, which is subject to Faculty of Health Sciences, of
     Cyprus University of Technology. The timely submission of the Application Form and necessary documentation (including Reference
     Letters) is the responsibility of the Candidate. Incomplete applications will not be processed to the Institute or evaluated. The
     University reserves the right to ask applicants to present the original documentation at any stage during or after the application
     process. The content of this Application Form will be treated as confidential.



For University Use Only

Department/Institute’s Code
                                                                                                                  Recent Passport
Masters Degree:                                                                                                     Size Photo

Position held for : (Date)

Α.      STUDENT GENERAL INFORMATION

1.        Passport or Civil Identity Card Number (please specify)

2.        Please complete the following :




Surname                                          Name                                            Maiden/ Spouse Name
      Current Correspondence Address
Street and number :
Town / District
Postal Code :

Country : CY: Cyprus                                               Other (specify)


Telephone Numbers                               Home                           Mobile
                                                              2
E-mail Address

Β.   STUDENT PERSONAL INFORMATION

1.     Sex: Male (Μ):                                      Female (F):


                                      /        /
2.     Date of Birth
                                 Day / month/ year



3. Do you give Student Welfare and Academic Affairs Service, of Cyprus University of Technology the right to publish your
   address and telephone to cultural, educational, advertising or other organizations?

     YES:                                                     NO:

                                                                                         /           /
     Student’s Signature                                                         day         month           Year
                                                                                                Date


4. Nationality:   CY: Cypriot                ΕU: European                              Other         _____________________
                                                                                               (Please specify)



C.   OTHER INFORMATION

1. Please select the Postgraduate Program to which you are applying:
     Master’s Level:                                          Doctoral Level:



2. Please specify the Title of the Program of Study to which you are applying:

………………………………………………………………………………………………
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D.    ACADEMIC QUALIFICATIONS
    EDUCATIONAL                    DIPLOMA/
      INSTITUTION                CERTIFICATE                 GPA          TITLE OF PROGRAM              DATE OF
(College, University etc)     (Bachelor’s, Master’s                                                   GRADUATION
                                      etc)




E. OTHER EXAMS/ CERTIFICATES (e.g. G.C.E, GMAT, TOEFL)

     EDUCATIONAL             CERTIFICATE                      SUBJECT                      GRADE          DATE OF
      INSTITUTION                                                                                       COMPLETION




F. COMPETENCY IN FOREIGN LANGUAGE(S)
   (Please gauge your competency in terms of the following scale 1: Excellent, 2: Very Good, 3: Adequate, 4: Inadequate)



              LANGUAGE                        READING       WRITING      SPEAKING
                                               LEVEL         LEVEL         LEVEL
                                                                                                                            4

G. WORK EXPERIENCE (Please provide details pertaining to your work experience, beginning with the most recent)
EMPLOYER’S NAME AND ADDRESS                                                                   POSITION/ TITLE/ DUTIES                                               DATE (FROM)                                DATE (TO)




H. RESEARCH EXPERIENCE (Please provide information regarding any Research Experience that you may have had in the
past)

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I.        PUBLICATIONS (Please provide details regarding any Publications that you may had in the past)
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J. AWARDS/ GRANTS (Please provide information regarding any Awards, Scholarships, Grants etc that you may have
received in the past, mainly in relation with the specific subject of fields)
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K. GENERAL INFORMATION (Please provide any other important information you feel that should be considered by the
Evaluation Committee)

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L. REFERENCE LETTERS (Please provide contact information for at least two Academic Referees. Kindly arrange
Reference Letters from two of these Referees to be sent directly to the relevant Department of the Cyprus University of
Technology)


        Full Name: ………….………………………………………..                                                                                             Full Name: ………….………………………………………..

        University/ Academic Institution:                                                                                              University/ Academic Institution:
        …………………………………………………………………                                                                                                      …………………………………………………………………

        Title/Position: ………………………………………………..                                                                                           Title/Position: …………………………………………………

        Address:………………………………………………………                                                                                                  Address:………………………………………………………
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        Telephone/ Fax Number: ………………………………..                                                                                          Telephone/ Fax Number: …………………………………..

        Email:…………………………………………………………                                                                                                   Email:……………………………………………………………


        Full Name: ………….………………………………………..                                                                                             Full Name: ………….………………………………………..

        University/ Academic Institution:                                                                                              University/ Academic Institution:
        …………………………………………………………………                                                                                                      …………………………………………………………………

        Title/Position: ………………………………………………..                                                                                           Title/Position: …………………………………………………

        Address:………………………………………………………                                                                                                  Address:………………………………………………………
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        Telephone/ Fax Number: ………………………………..                                                                                          Telephone/ Fax Number: …………………………………..

        Email:…………………………………………………………                                                                                                   Email:……………………………………………………………
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    I certify that the above information is correct. Furthermore, I agree to abide by the Rules and Regulations of the Cyprus
    University of Technology.


                                                                                  /           /
Candidate’s Signature                                                      day        month          year
                                                                                         Date


NOTE: CHECKLIST OF IMPORTANT DOCUMENTS TO BE SUBMITTED WITH APPLICATION

     Before sending the application, please make sure that the following documentation is submitted with your application:

            1) Completed and Signed Application Form. Empty application form is attached.
            2) Complete Curriculum Vitae
            3) Copy of Civil Identity Card/ Passport
            4) A 500-word Essay written by the applicant. The essay should describe the applicant’s academic and
             professional history, reasons for wanting to enroll in the degree program, and professional or academic career
             plans upon completion of the program.
            5) Copy of Bachelor(s)
            6) Copy of Official Grade Transcript of Bachelor(s). Applicants are expected to have a distinguished
             undergraduate record, as well as excellent performance in any graduate work undertaken.
            7) Letters of Recommendation from at least three people who are well acquainted with the applicant's academic
             work and/or professional experience. Empty form of Recommendation Letter is attached.
            8) Applicants from countries where English is not the language of instruction must submit one of the following
             certificates of English Language. Those who have already taken the TOEFL may submit the score of 83 or above
             as long as it is not more than three years old. The International English Language Testing System (IELTS) exam
             will be accepted if the applicant's score is 7.0 or above.
            9) Official English translations should be provided for degrees and transcripts from Universities where English is
             not the language of instruction.
            10) Completed scholarship application form for candidates who apply for a scholarship
            11) Official scores of the Graduate Record Examination (GRE) are recommended but not required. Those who
             have already taken the GRE may submit the score as long as it is not more than six years old.

Please note that only the Reference Letters which bear an original signature and are submitted in a sealed envelope
will be accepted. Reference Letters which are sent electronically will not be accepted.
                           7
FOR OFFICIAL USE ONLY

Department’s/ Institute’s Comments on Candidate:
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   The Candidate is:

   Accepted:                               Not Accepted:


Date: ……………………

				
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