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Application for Admission / Page 1

Application for Admission to the MSc/PhD/MD-PhD Neuroscience Program COVER SHEET


Instructions:
This pdf file can be downloaded or processed in your browser window. You may enter all relevant information and print the form by using the print button (p. 8). System requirements: Windows PC or Macintosh with Adobe Acrobat Reader 4.0 or higher. Important: Be aware that this file does not allow you to save the information you have entered! All data will be cleared when closing the file, so make sure to print the form before closing it! Please send this cover sheet (p. 1) together with the application form (pp. 2-7), the financial statement (p. 8), two photos and all relevant documents (see checklist, p. 7) in hard copy to our coordination office. A Reference Report Form is available as a separate file. Please forward it to two academic teachers of your choice who are able to evaluate your personality, academic experience and intellectual merit. The reference letters can be included in your application package, preferably in closed envelopes, or can be sent to the coordination office directly by the referees. Prior to sending this application, you need to register online (http://www.gpneuro.uni-goettingen.de). During online registration you will be asked for entering a similar data set as in this application form. Upon successful online registration you will receive a registration number which needs to be indicated below. Notice that online registration serves the purpose of accelerating the selection and admission procedure but DOES NOT substitute for sending this application form and the required documents by post. Deadline for application is January 15 for courses starting in fall of the same year.

This application is intended for enrollment in Registration Number:

Fall 20

(indicate year)

(indicate the number you received upon successful online registration)

DO NOT WRITE IN THIS AREA

Last Name: First Name: Middle Name(s): Date of Birth (dd/mm/yy): Nationality: Current Address* / City: Current Address* / Country: Current Address* / State: Latest Degree:
(awarded or expected this year)

AP TR DI R1 R2 EC FS FO C B A

Major Subject(s):
*for correspondence DURING the application and admissions process (i.e. valid until the end of March)

Contact: Prof. Dr. Michael Hrner, Program Coordinator, Grisebachstr. 5, 37077 Goettingen, Germany Phone: +49-551-39 12307/91244, Fax: +49-551-39 12308, gpneuro@gwdg.de, http://www.gpneuro.uni-goettingen.de

Application for Admission / Page 2

Application for Admission to the MSc/PhD/MD-PhD Neuroscience Program


1. Personal Information
1.1 Personal Data

Last Name

First Name

Middle Name(s)

Date of Birth (dd/mm/yy)

Place of Birth (city / country)

Nationality

male

female

single

married

No. Children

E-Mail Address

Registration Number (issued after successful online registration)

1.2 Current Address: (please indicate the address to be used for correspondence DURING the application and admissions process)

Street

Postal Zip Code

City

State (if applicable)

Country

Telephone Number

Fax Number (if applicable)

1.3 Permanent Address: (if different from 1.2, please indicate the address to be used for correspondence AFTER the
application and admissions process, e.g. home address, address of parents or relatives)

Street

Postal Zip Code

City

State (if applicable)

Country

Telephone Number

Fax Number (if applicable)

Please indicate how you learned about the program (check all that apply): Poster, Flyer, posted at/distributed by Internet Website Friends, colleagues, faculty members, other students College or University Office Conference/Workshop/Science or Education Fare, specify Other, specify

Contact: Prof. Dr. Michael Hrner, Program Coordinator, Grisebachstr. 5, 37077 Goettingen, Germany Phone: +49-551-39 12307/91244, Fax: +49-551-39 12308, gpneuro@gwdg.de, http://www.gpneuro.uni-goettingen.de

Application for Admission / Page 3

2. Education
2.1 Colleges or universities attended / degrees awarded or expected. College / University (most recent enrollment) College / University (previous enrollment)

Institution
Name City Country

Enrollment
Major Subject(s) Dates attended *Grade Point Average
from achieved till max. possible from achieved till max. possible

Degree
Title (e.g. B.Sc.; M.Sc.) Date of completion

2.2 *Thesis Advisor:

2.3 *Title of Thesis:

2.4 *Description of Thesis Project:


Briefly summarize experimental approach, methods used, and key results obtained in your thesis project.

*if applicable
Contact: Prof. Dr. Michael Hrner, Program Coordinator, Grisebachstr. 5, 37077 Goettingen, Germany Phone: +49-551-39 12307/91244, Fax: +49-551-39 12308, gpneuro@gwdg.de, http://www.gpneuro.uni-goettingen.de

Application for Admission / Page 4 2.5 Academic Background / Self-evaluation


Indicate whether you attended courses in the subjects listed below for at least 2 semesters. Please evaluate your background knowledge in each subject (excellent = 1, good = 2, fair = 3, none = 4)

Course Neuroscience Cell Biology Biochemistry Biotechnology Microbiology Botany Zoology Chemistry

yes/no / / / / / / / /

2.6 Language and Subject Tests: Have you taken or do you plan to take the Test TOEFL IELTS GRE General Test yes/no / / verbal / overall GRE Subject Test in:
enter name of test

Date (mm/yy)

Score

quantitative

analytical

Language spoken and used for teaching at your educational institution:

2.7 Honors, Scholarships, Prizes, Awards


In the space below, list honors, scholarships, prizes, awards or other evidence of merit, with dates and a short description.

2.8 Research and/or Teaching Experience

Contact: Prof. Dr. Michael Hrner, Program Coordinator, Grisebachstr. 5, 37077 Goettingen, Germany Phone: +49-551-39 12307/91244, Fax: +49-551-39 12308, gpneuro@gwdg.de, http://www.gpneuro.uni-goettingen.de

Application for Admission / Page 5

3. Curriculum Vitae
Please list all educational and professional activities in reverse chronological order (from now till the end of high school) without leaving periods of more than one month unmentioned.

From - Till

Activity

Contact: Prof. Dr. Michael Hrner, Program Coordinator, Grisebachstr. 5, 37077 Goettingen, Germany Phone: +49-551-39 12307/91244, Fax: +49-551-39 12308, gpneuro@gwdg.de, http://www.gpneuro.uni-goettingen.de

Application for Admission / Page 6

4. Interests and Goals


4.1 Areas of scientific interests:

4.2 Motivation for Program Entry


Please use this page to explain your motivation to pursue advanced study in neurosciences, referring to any personal, professional, or educational experiences or situations that have contributed to your desire to participate in this program. Describe your specific interests and academic goals. Do not exceed the space provided.

4.3 Non-academic Interests (optional)

Contact: Prof. Dr. Michael Hrner, Program Coordinator, Grisebachstr. 5, 37077 Goettingen, Germany Phone: +49-551-39 12307/91244, Fax: +49-551-39 12308, gpneuro@gwdg.de, http://www.gpneuro.uni-goettingen.de

Application for Admission / Page 7

5. References
Please list the names, positions, e-mail addresses and phone numbers of two referees who will write letters of recommendation for you. It is recommended that referees use the reference report form which is available on the programs website and send the letter directly to the coordination office until January 15.

6. Other Applications, Previous Applications


Please indicate whether you have applied to other MSc or PhD programs and whether you have applied for the Neuroscience Program in Gttingen before. Applications at other places or previous applications in Gttingen will not affect decisions in this application cycle!

Assurance of complete and truthful information and statutory declaration


I submit my application for admission to the Msc/PhD/MD-PhD Neuroscience Program with the above information. I affirm the completeness and truthfulness of my responses to the above questions. I am aware that false answers, whether intentional or the result of negligence are illegal, and that their discovery could lead to the revocation of my admission. I am in consent with the storage of my personal data for application and admission purposes. Name: Date:

Financial Aid / Application for Scholarships There is a limited amount of scholarships available through the program. If you intend to apply for one of them, please explain your financial situation on a separate form attached to this application. Admission to the program is unaffected by the need for financial aid!

Checklist for Application to the MSc/PhD/MD-PhD Program in Neuroscience Required Documents until January 15 (1) Cover sheet (p. 1 of this file): 1 copy. (2) Application Form (pp. 2-7 of this file): 2 copies of completed application form (signed). (3) Official Transcript / Record of Studies: of all colleges/universities attended; in English or German; 1 copy. (4) Diplomas: certificates of relevant examinations (e.g. Bachelors or Masters degree, Vordiplom, Physikum); in English or German; 1 copy of each document. (5) 2 Photographs: indicate your name on the back of both photos! (6) Financial Statement (p. 8 of this file): 1 copy. Notice that your application will NOT be processed if items 1-6 arrive late or are incomplete. Additional Documents (7) Reference Letters: signed letters of two academic teachers who are able to evaluate your personality, academic experience, and intellectual merit (in closed envelopes; preferably mailed directly to the coordination office). The use of the attached reference report form is recommended; reference letters submitted after January 15 will not be acknowledged in the evaluation of your application. (8) Proof of proficiency in English: if applicable (see website for details); preferably until January 15; acceptable after the application deadline. Optional (9) GRE Scores: official score reports of the Graduate Record Examination. The Subject Test in Biology, Chemistry, Physics or Cell and Molecular Biology is recommended but not required. How to proceed from here? After successful completion of your online registration, please send all documents listed in the checklist above to the program coordination office by air mail or surface mail. Notice that your application can only be processed after we have received your complete application form together with all relevant documents. Deadline for submission is January 15 of the year in which you intend to enter the program. Late or incomplete applications will not be accepted!

Contact: Prof. Dr. Michael Hrner, Program Coordinator, Grisebachstr. 5, 37077 Goettingen, Germany Phone: +49-551-39 12307/91244, Fax: +49-551-39 12308, gpneuro@gwdg.de, http://www.gpneuro.uni-goettingen.de

Application for Admission / Page 8

Financial Statement (required from all applicants)


Please state here how you plan to meet the full expenses of your stay in Gttingen, Germany (minimum amount required: 500 Euros per month):

Do you require financial aid and want to apply for a scholarship through the program?
Admission to the program is unaffected by the need for financial aid!

yes

no

Application for Financial Aid (optional)


There is a limited amount of scholarships available through the program. If you intend to apply for one of them, please explain your financial situation:

Printout
Please use the button below for printing this file. One hard copy should be kept for your records. Two hard copies of the entire file need to be submitted to the coordination office. Be reminded that this file does not allow you to save the data you have entered! All data will be cleared when closing the file.

Contact: Prof. Dr. Michael Hrner, Program Coordinator, Grisebachstr. 5, 37077 Goettingen, Germany Phone: +49-551-39 12307/91244, Fax: +49-551-39 12308, gpneuro@gwdg.de, http://www.gpneuro.uni-goettingen.de

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