MSc Medical Technology Application Form 2002



MSc Candidate Application FormMaster’s Program Biomedical EngineeringTO BE FILLED IN BY APPLICANT (INTERNATIONAL STUDENTS)A. Personal Data1. Surname Family Name: FORMTEXT ?????2. Birth Name Maiden Name: FORMTEXT ?????3. First Name(s) FORMTEXT ?????4. Date of Birth FORMTEXT ?? FORMTEXT ?? FORMTEXT ????(day) (month) (year)5. Sex: male = m FORMCHECKBOX female = f FORMCHECKBOX 6. Place of Birth FORMTEXT ?????7. Correspondence Address FORMTEXT ?????Street and House Number FORMTEXT ?????Postcode FORMTEXT ?????Place of Residence (city) FORMTEXT ?????Country8. Citizenship FORMTEXT ?????9. Telephone (incl. Int. Code) FORMTEXT ?????10. E-Mail FORMTEXT ?????You must have an international English language certificate or you fulfill one of the issues listed below. (Detailed information: ) FORMCHECKBOX Proof of English proficiency FORMCHECKBOX Internationally accepted language test in English (e. g. TOEFL?; IELTS?; CAE) FORMCHECKBOX English was the official language in school FORMCHECKBOX At least ? year of working or studying in an English-speaking country FORMCHECKBOX English was the official language of Bachelor/Master’s studiesMSc Candidate Application FormMaster’s Program Biomedical EngineeringB. Curriculum VitaeAcademic QualificationsName and Location of Universities, Colleges or Polytechnics where you acquired your degrees Best grade(theoretic best grade)Worst grade(to pass the course of study)1. FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2. FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Please fill in the general margins of the grade system of the university, where you acquired your degreeCorrect term of the degree and the field of study (e.g. Bachelor of engineering in Biomedical Engineering)Frommm/yyyyTomm/yyyyStandard length of your Bachelor’s programYour final grade (GPA)1. FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2. FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Previous/Current EmploymentName/Address of EmployerFromToPosition FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Level of German knowledge A1 FORMCHECKBOX A2 FORMCHECKBOX B1 FORMCHECKBOX B2 FORMCHECKBOX other FORMCHECKBOX (only for International applicants)MSc Candidate Application FormMaster’s Program Biomedical EngineeringOther Experiences/SkillsPlease submit further information relevant for your application FORMTEXT ?????I confirm that the information given in my application is true, complete and accurate. No information requested has been omitted. I know that incorrect statements may lead to a cancellation of my application.Please take into account: The studies are free of tuition fees. Only a charge of approximately 75 Euros has to be paid once for the application, if you have to apply with Uni-Assist in Berlin. Additionally, all students have to pay a semester fee of about 120 Euros after their arrival in Lübeck and a registration fee of 50 Euro only once. Please do not pay anything to mediating persons. Such payments do not increase your chances for admission to the studies in any way. Please send your application documents directly to the address given below. FORMTEXT ????? FORMTEXT ?????Place/Date Signature of Applicant(1)Applicants from China, Vietnam and Mongolia have to apply at “Akademische Prüfstelle - APS” of the German embassy in Beijing. ................
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