Apply

Application Form

I am Aware that this is an application form for both target group 1 ( TG1) and target group 2 (TG2)

I have read and Understood the application procedures as described in the call.

Have you Ever Benefited from an Intra-Africa Mobility Program?

Target Group

Names *

First

Middle

Last

Date of Birth

Place Of Birth

Sex

Address

Permanent Address

Email *

Phone Number

Nationality

Identification Card Number/Passport Number

Country Of Residence

Language Spoken

Home Institution

For Trainees, Staffs and Credit Seeking Mobilty

City

For Trainees, Staffs and Credit Seeking Mobilty

State/Province/Region

Zip/Postal Code

Contact Person (Names/ Tel/ Email address)

Type of Mobility

First Choice of Host Institution

Why have you chosen this specific institution? ( For Trainees: What do you intern to learn during your training in the institution?

Max 1000 Characters

Have you establish any previous contacts with the institution concerning your mobility? If Yes, Quote the name of your contact person and his/her position

Programs applied for at the host university ( For trainees summarize the learning outcome. For staff : Summarize the teaching and research activity )

Max 1000 Character.

Second Choice of Host Institution

Why have you chosen this specific institution? ( For Trainees: What do you intern to learn during your training in the institution?

Max 1000 Characters

Have you establish any previous contacts with the institution concerning your mobility? If Yes, Quote the name of your contact person and his/her position

Programs applied for at the host university ( For trainees summarize the learning outcome. For staff : Summarize the teaching and research activity )

Max 1000 Character.

Third Choice of Host Institution

Why have you chosen this specific institution? ( For Trainees: What do you intern to learn during your training in the institution?

Max 1000 Characters

Have you establish any previous contacts with the institution concerning your mobility? If Yes, Quote the name of your contact person and his/her position

Programs applied for at the host university ( For trainees summarize the learning outcome. For staff : Summarize the teaching and research activity )

Max 1000 Character.

Degree 3

Grade

University Obtained

Year of completion

Specialization/Program

Degree 2

Grade

University Obtained

Year of completion

Specialization/Program

Degree 1

Grade

University Obtained

Year of completion

Specialization/Program

Employment 1 ( Name of Organization / Name and Address of Employer)

Duration

Employment 2 ( Name of Organization / Name and Address of Employer)

Duration

Employment 3 ( Name of Organization / Name and Address of Employer)

Duration

Publications or any other evidence of research experience

5 most recent publications

Motivation and added values

Please state the main reasons why you wish to participate in this project, as well as the added value you perceive your mobility proposal will bring to your host institution. (1000 Character max)

Referee 1 ( Name , Institution, Position Held, Email, Phone, Address

Referee 2 ( Name , Institution, Position Held, Email, Phone, Address

I confirm that i do not have any running scholarship at the time of application *

Confirm

I confirm that i have attached all necessary documents required for this application *

Confirm

By submitting this application, I declare that the information provided in this application and the supporting documentation is true and complete. I understand that the ANCRES Project reserves the right to withdraw or cancel any offer made on the basis of information that proves to be untrue or misleading. I accept that the information I provide on this form and during my enrolment can be provided, in certain circumstances, to the European Commission (Intra-Africa Mobility Scheme) and designated authorities, including publishing it on the project website. I understand that the ANCRES project will keep all my personal information confidential unless otherwise. *

Confirm

Student Research Proposal ( for MSc & PhD )