CONSEIL INTERUNIVERSITAIRE DE LA COMMUNAUTE FRANCAISE DE BELGIQUE COMMISSION UNIVERSITAIRE POUR LE DEVELOPPEMENT INTERNATIONAL COURSES AND TRAINING PROGRAMMES 2012-2013

Please stick here a recent ID photograph

Please read carefully

1- Fully complete this form (where possible in type-writing) 2- Join to the form all documents requested 3- Return the form to the CUD secretariat, duly completed, dated and undersigned, together with the requested documents, by February 13, 2012

Application file for a scholarship and admission form to one of the French speaking universities of Belgium

Only application files presented on the adequate form and supplemented in the language in which the training is given will be taken into consideration

International Course for which a scholarship is applied for :

Master complmentaire in Public Health Methodology European Microfinance Programme Advanced Master in International and Development Economics

I.
Mr

Personal data of the candidate

Mrs

(to be completed in capital letters)

Ms

NAME... For married women, please maiden name : . FIRST NAMES. NATIONALITY . AGE : (No follow-up will be given to the files of candidates who do not comply with this rules of selection: less than 40 years old for the courses, and less than 45 years for the trainings, at the time of the beginning of the programme) PLACE OF BIRTH (town and country) : ..... DATE OF BIRTH (day, month, year): .../../19 COMPLETE POSTAL ADDRESS : (Street, number, PO Box) ..... ZIP Code : .. Town : ..Country : . MARITAL STATUS Single Married Divorced or separate Widow

These data will enable us to inform you about the follow up of your file. Please indicate complete data
International Courses and Training Programmes 2012 - Application File for a Scholarship and Admission Form 1

CONTACT NUMBERS* : TELEPHONE (Country code town code telephone number) professional private ..

TELEFAX (Country code town code - telefax number) .... E-MAIL : .. Remark : e-mail is an excellent means of communication. Please mention wherever possible an e-mail address. If you do not have an e-mail address, you may mention the e-mail address of an acquaintance, a secretariat, The selected candidates will be informed by electronic mail of their selection and will have to quickly confirm their participation in the formation quickly. It is thus important to mention a reliable and CORRECT ELECTRONIC ADDRESS. NAME, FIRST NAME and PROFESSION OF SPOUSE : .. .. NUMBER OF CHILDREN :

II.

Secondary studies

Date of end of secondary studies (Month) (Year) . Name of school establishment, country : ...... . Option : Results : ..

III.

Higher education

The file must be accompanied by the certified copy of your diplomas and detail of results. The

files which do not answer this criterion will be automatically rejected.

Please specify the studies followed in your country of origin or abroad (university and non-university higher education) and first indicate the main degree obtained. Please join all documents requested in particular the detail of results obtained. Join a certified copy of all your titles and degrees. These elements are essential for introducing your file with the academic authorities of the organising University. These authorities play a major role in the selection process. Applicants to an international training programme do not have to complete the admission file.

International Courses and Training Programmes 2012 - Application File for a Scholarship and admission form

A line per academic year must obligatorily be supplemented. The white or redoubled years must also be mentioned. Academic year Ex.: 1991-1992 Name of studies and/or of degree obtained Name of institution and country Results (even in case of failure)

University degrees (undergraduate, graduate, master, ) : . .

International Courses and Training Programmes 2012 - Application File for a Scholarship and Admission Form

List of publications (please join list in annex, where necessary) : . . . .

Did you follow short term training? no yes

If yes, please specify (Join list in annex where necessary) Please specify the location, institution, year, and where appropriate the organisation that has financed a scholarship . . . . . . .

Have you had the benefit of a scholarship in the past ? no yes

If yes, please specify. Please indicate the location, the institution, the year and the organisation that financed the scholarship. . . . . .

Have you filed, for the academic year 2012-2013, an application for a scholarship with another organisation ?

no

yes

If yes, with which organisation ? :

International Courses and Training Programmes 2012 - Application File for a Scholarship and admission form

IV.

Professional experience (including current job) in development country

Candidates must show professional experience of at least two years upon termination of their studies. Where candidates are holders of a postgraduate degree delivered by an university of an industrial country, they must show professional experience of at least three years upon termination of their studies

TO MANDATORILY FILL IN, INDEPENDENT FROM POSSIBLE ANNEXES THAT YOU WILL JOIN TO YOUR FILE. Please join all documents requested in particular the detail of results obtained, as well as, if you so wish, any letter of recommendation of your current and/or past employers.

Period

Nature of the occupation

Employer

Ex.: from 01/01/1991 to 01/03/1991

the Ex : Employed as medical doctor, legal Ex : place of work (hospital, the counsellor, ministerial department,)

Please turn

International Courses and Training Programmes 2012 - Application File for a Scholarship and Admission Form

V.

Current job

Employer : . Function : ..

Will your employment be guaranteed by your employer upon your return

no
If yes, please join a promise of reinstatement.

yes

COMPLETE PARTICULARS OF THE EMPLOYER :

NAME : FIRST NAME : ADDRESS : . TELEPHONE : .TELEFAX: . E-MAIL :

International Courses and Training Programmes 2012 - Application File for a Scholarship and admission form

ONLY FOR STUDENTS APPLYING TO AN INTERNATIONAL COURSE Dependent persons :

Allowances for dependent persons are exclusively granted to students, not to participants in training programmes. Please indicate, in capital letters, the complete name and first names of your spouse and children. Only the spouse and children under 18, legitimate or legally adopted, are taken into consideration (in case of legal adoption, a decision of the Court, legalized by the Ministry of Foreign Affairs and the Embassy of Belgium in the country, will be delivered). From the date of the grant application and throughout the year of the award, no additional adoption will be taken into account. Data provided in this form commit the applicant, in case of selection, to present, immediately upon arrival in Belgium, the certificates (marriage certificates and birth certificates legalized by the Ministry of Foreign Affairs and the Embassy of Belgium in the country) proving the composition of his (her) family. Any omission in this form will be at the risk of the applicant. Any modification of family composition occurring between the transmission of this form and the arrival in Belgium must be declared in writing to the Belgian university of reception, before arrival in Belgium, and duly proven by a certificate an original document or certified copy. The CUD secretariat should not be sent any documents. These documents should be presented to the host university upon arrival of the scholarship recipient in Belgium.

Dependent person

Parental link

Date of birth

Given the difficulties linked to complex procedures for joining Belgium, CUD does not recommend your family to accompany you. CUD will not undertake any steps to assist scholars in this context.

VI.

Knowledge of languages

For courses and training programmes lectured in English, good written and spoken knowledge of English is requested. The knowledge of French is recommended for the daily life in Belgium VG = very good - G = good - W = Weak

Language English French

Oral comprehension

Reading comprehension

Speaking ability

Writing ability

International Courses and Training Programmes 2012 - Application File for a Scholarship and Admission Form

VII.

Motivation

The motivations must be indicated below (maximum 1 page). Annexes will not be taken into account. 1Please explain the reasons for your application to the course or training programme :

. . . . . . . . . . . . . . . . . . . . . . . . .

International Courses and Training Programmes 2012 - Application File for a Scholarship and admission form

2Please describe how you will put this programme followed in Belgium in practice upon your return to your country (join annexes where necessary) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
International Courses and Training Programmes 2012 - Application File for a Scholarship and Admission Form 9

Important instructions :
You are invited to indicate your possible preference concerning the University of registration. However, C.U.D. may not be committed to systematically respect this preference. : University of admission chosen: . This file must be complete (where possible in type-writing) and reach, in one copy, BY POSTAL OR EXPRESS MAIL at the following address: The Secretariat of the Commission Universitaire pour le Dveloppement 72-74, rue de Namur B-1000 Bruxelles Telephone: + 32 2 289 65 60

by February 13, 2012 at the latest

In order to be taken into consideration, this application form must be integrally completed, within the appropriate columns. If you wish to complete this document with annexes, you are welcome to do so, but all particulars that are requested must mandatorily be integrated into the form. Files that are incomplete and limited, in part or in whole to a reference to annexes will be rejected. No acknowledgement of receipt will be provided. All applicants will be informed by e-mail on the results of the selection process. In addition, these results will be available on our Web site (www.cud.be) as from June 2012. Only application files presented on the adequate form will be taken into consideration. No document sent to C.U.D. will be returned to the applicants. In case of non-selection of a file, and if you wish to introduce later on a new file, it will be necessary to constitute a new file, on new forms available on the CUD website, as from November of the year before the organisation of the programme you wish to follow. No followup will be granted to applications for renewal of files for a subsequent year. No follow-up will be granted to application files that are introduced beyond the deadlines set above. The application file must reach the C.U.D. secretariat, by postal mail, in a single consignment. No separate documents will be accepted. The file must be accompanied by the parts to join obligatorily (certified copy of the diploma...)
International Courses and Training Programmes 2012 - Application File for a Scholarship and admission form

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It is necessary to testify to a sufficient professional experience after obtaining the university diploma

In case of selection, the scholarship recipient will receive information regarding his arrival at the airport (or the Brussels train station) as well as his accommodation. These will be sent by e-mail several weeks before the date of departure. Therefore, it is strongly recommended to check email regularly, upon information about selection. Where the recipient does not wish to take advantage of the above arrangements, he must inform his host university as soon as possible and must, in any case, notify the host university before arrival in Belgium. In case the recipient organises his own arrangements for arrival and/or accommodation in Belgium, CUD and the host university are exempted from any duty in this respect, effective as soon as such notification is received from the recipient. In case the recipient organises his own arrangements for arrival and/or accommodation in Belgium but fails to notify, he may be required to reimburse CUD and/or the host university for any expenses incurred there to related. The scholarship recipient is aware that the programme for which he could be selected requires assiduous attendance of those courses provided as well as demanding personal exertion. He will notify C.I.U.F. of any particular situation concerning his mental or physical health which could have an impact on his course attendance or personal work output (pregnancy, illness ...) upon presentation of his application file and, in any other case, as soon as he is aware of this state. In the event that he fails to provide this required information, the host university cannot guarantee good housing conditions of the scholarship recipient, nor an adequate follow-up.

List of documents that must be mandatorily joined :

1- An I.D. photograph (to be clipped on page 1). 2- A copy certified as corresponding to the original of all your degrees, together with their translation (established by a sworn translator)into French, save where they are established in Dutch, English, German, Spanish, Italian or Portuguese. 3- A list of results obtained and courses attended, in one of the languages mentioned above, year by year, for each of your study years in Higher Education (University or Non-University). In case of failure, a certificate of attendance dated after January of the year concerned . These documents must be established by the competent institutions, bear their original stamp or be certified as corresponding to the original. 4- Official justification of activities or certificates of employment for the last five years (2007-2008, 2008-2009, 2009-2010, 2010-2011, 2011-2012). 5- A short report presenting the reasons of your application for the programme and the projects you consider to be able to develop. 6- An official certificate of nationality (document certifying the nationality of the student, not the certificate of birth), delivered by the Civil Municipal Authority, the Embassy, the Consulate, the Ministry of Justice, 7- A list of publications and active participation to scientific events. 8- Two letters of recommendation of either members of academic staff or members of professional institutions.

In case of non-selection, the present admission form and its annexes neither will be transmitted to the universities, nor returned to the candidate.

International Courses and Training Programmes 2012 - Application File for a Scholarship and Admission Form

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Statement of honour
I, undersigned, declare upon my honour that the particulars provided in this application form, included those concerning my marital status and the composition of my family, are sincere and truthful. If I would be granted a scholarship, I commit myself to the following: a) to register with the University of admission in order to attend the above mentioned programme and to use my best endeavours to terminate the programme with the best results and within the shortest time limits. I am not authorised to amend, at my own initiative, the programme prepared for my attention, nor to extend my stay in Belgium in order to attend another programme ; to respect the regulations of the University of admission and stay in Belgium during the whole duration of the academic year, safe for express authorisation by the academic responsible ; to return to my country of origin at the end of the above mentioned programme ; upon termination of the studies concerned by the scholarship, to put my skills at the service of the development of my country of origin ; to draw up a report concerning my stay in Belgium and the implementation of my programme. This report will be signed by the lecturer in charge. Signature of de candidate

b) c) d) e)

Date : .

How have you been informed about the availability of scholarships? By the Belgian Embassy By the Wallonie-Bruxelles delegation By a local university By an acquaintance By the CUD web site By a local ministry By the local press Any other means : .

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International Courses and Training Programmes 2012 - Application File for a Scholarship and admission form