��ࡱ� > �� ���� ������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������ q` �R� S bjbjqPqP = : : @ �� �� �� � � � � � � � � � �P �P �P 8 �P | BQ D � � , �T �T " �T �T �T �U �U �U ~� �� �� �� �� �� �� $ C� h �� T �� - � �V �U �U �V �V �� � � �T �T � ф �Y �Y �Y �V � � �T � �T ~� �Y �V ~� �Y �Y 6 s < � � �u �T �T ��^��� �P �W � Zt bv � 0 � vt � �� \X �� 8 �u �� � �u h �U > �U , �Y �U $ V � �U �U �U �� �� nY X �U �U �U � �V �V �V �V � � � �H �P � � � �P � � � � � � � � � ���� D��N5 C A S A g r e e n i u m J O I N T D O C T O R A L P R O M O T I O N P R O G R A M M E ( D P P ) R E G I S T R A T I O N F O R M P e r s o n a l I n f o r m a t i o n A t t a c h P h o t o M i s s / M s / M r s / M r R e g i s t r a t i o n n u m b e r ( p l e a s e l e a v e b l a n k ) S u r n a m e ( F a m i l y N a m e ) , F i r s t N a m e ( G i v e n N a m e ) N a t i o n a l i ty GenderMarital StatusDate of Birth (day, month, year)Male Single Female Married Place of BirthNumber of Children: ____Correspondence Address Address to which all correspondence will be sentPermanent Home Address (if different from correspondence address)Address TelephoneFax (if applicable)Email Academic History Higher education institutes attended (university, polytechnic college or other) Dates (mm/yy � mm/yy) Name of Institution / Place / CountryPrincipal Subject (s) Degrees awarded or expected before joining the DPP Date of Award (day/month/year)Exact Degree Title (BSc, MSc, Diploma etc.)SubjectScore (Marks, Points)ObtainedMax.*Min. ** Maximum score (marks, points) that can be obtained, ** Minimum score (marks, points) required to pass Honours, Scholarships, Prizes List any honours, prizes and awards you have received relevant to this application, with dates and short description Thesis Title of your Master or Diploma thesis, also indicate the name of your supervisor List of Publications, Patents etc References First RefereeSecond RefereeName:Occupation:Address: Phone:Fax:Email: Language Skills Languagenativevery goodgoodfairpoorEnglishFrench EnglishScore(s)DateIELTS (TOEFL (Other (please specify) (Other information proving English proficiency: Other Relevant Information Or Remarks Research Proposal 1) Proposal for candidates With subject for Ph.D. thesis and Ph.D. supervisor in China Title of your Ph.D. thesis Ph.D. SupervisorName:Position:Address: Phone:Fax:Email: Name of labs you would like to go to / that fit your scientific interest: a) Name:Supervisor:Address:Phone:Fax:Email: b) Name:Supervisor:address:Phone:Fax:Email: c) Name:Supervisor:address:Phone:Fax:Email: Write a short research proposal on the scientific work you would like to do if you had the relevant resources and equipment. You are welcome to develop your own ideas. Alternatively you may look up recent publications of relevant members of faculty as a starting point. Family Information These details are needed in case your family will join you during your stay in France Do you want your family to join you during your stay in France? YesNo Spouse: Surname (Family Name), First Name (Given Name)Date of BirthPlace of Birth Children: Surname ( Family Name), First Name (Given Name)Date of BirthPlace of Birth Surname ( Family Name), First Name (Given Name)Date of BirthPlace of Birth Notes for Guidance Before completing this registration form, please read the following information carefully. Please use A4 size paper only and do not staple. Please either type or complete this form by using block capitals throughout. Complete all sections of the registration as fully as possible. If a section does not apply to you please indicate this with N/A for not applicable. Please do not add any original certificates. 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