General_Application Form.pdf
- 1. SCHOLARSHIP PROGRAMME FOR CITIZENS OF THE OIC AND THE NAM MEMBER COUNTRIES APPLICATION FORM *Please fill with capital letters PERSONAL DETAILS First name _____________________________________ Surname ______________________________________ Gender Male Female Marital status Single Married Divorced Widowed Date of birth __________________ Citizenship ______________________ (dd/mm/yy) Passport Number _______________ Passport Expiration Date ___________ CONTACT DETAILS Home address_____________________________________________________________________ _________________________________________________________________________________ Current address (if different) _________________________________________________________ _________________________________________________________________________________ Home telephone number _________________ Mobile phone number ______________________ Fax number ____________________________ Email _____________________________________ Contact person in case of emergency Name, Surname __________________________ Relationship to you _______________________ Telephone number ________________________ E-mail __________________________________ Ministry of Foreign Affairs Republic of Azerbaijan PHOTO 1
- 2. ACADEMIC BACKGROUND Please list all academic institutions you have attended and qualifications you have obtained (the most recent first) Year Institutions Qualification Subject Language of study PROFESSIONAL EXPERIENCE Please list the institutions where you have worked (the most recent first) Year Institutions Position 2
- 3. KNOWLEDGE OF LANGUAGES Please list the languages you have proficiency (rate yourself as “excellent”, “good”, “fair” and indicate IELTS or TOEFL test score, if you have) Language Speaking Reading Writing Test score (if available) PROPOSED STUDY IN AZERBAIJAN A. Which academic qualification would you like to obtain within current scholarship programme? Bachelor Master Doctoral General medicine/residency B. Which subject would you like to study? ___________________________________________________________________________ C. In which language would you like to study? Azerbaijani Russian English D. Please prioritise three universities based on your preference at which you would like to study (refer to the attached list of universities). 1. ___________________________________________________________________________ 2. ___________________________________________________________________________ 3. ___________________________________________________________________________ 3
- 4. STATEMENT OF PURPOSE Please reflect on your interest to study in Azerbaijan, your aspiration to obtain relevant academic qualification for your proposed subject and your future plans after successful accomplishment of this programme (no more than 500 words) 4
- 5. REFEREES Please provide the names of two referees below who can evaluate your suitability for the program of study. Name and surname Institution and position Contact details CHECKLIST FOR APPLICATION PACKAGE Please be sure that you have included the following items in your application package Completed application form Diplomas and transcripts from prior high school or university studies Curriculum Vitae (CV) or resume Copy of international passport Document on general health status (including HIV/AIDS, Hepatitis B and C tests) Certificate on language proficiency (if available) SIGNATURE I confirm that the information provided in this form is accurate and correct to the best of my knowledge. Signed _____________________________ Date ____________________________ 5