The information in this application form is dedicated to the candidates selection to the EUROPHOTONICS Master program,

and shall not be shared with others for any other purpose

Application form
EUROPHOTONICS Master Erasmus Mundus
Academic years 2011-2013

All the cells that you have to fill in are colored in light green. For the printed version, you can use an uncolored background.

Family status
Family Name (=surname as written in your passport) GEBREGIORGIS
First name (as written in your passport) ASHENAFI WELDEMARIAM
Gender (M=Male, F=Female) M
Nationality (as written in your passport) ETHIOPIAN
Date of birth (DD/MM/YYYY) 12/09/1983
Place of birth BIZET
Country of birth ETHIOPIA
ID / Passport number EP0507455
Permanent personal address P.O.Box: 3174 Mekelle University Main Campus, Mekelle, Ethiopia
City MEKELLE
Postal Code 251
Country ETHIOPIA
Phone number (which can be used to contact you) +251914717188
Email washenafi@gmail.com
Name of person to be contacted in case of emergency DAWIT WELDEMARIAM
Phone number of contact person +251914717272
Marital status (single, married, … ) SINGLE
Children (0, 1, …) 0
Name of Home institution MEKELLE UNIVERSITY
Department Laboratory PHYSICS
Address - country P.O.Box: 231 Mekelle University Main Campus, Mekelle, Ethiopa
Phone number +251344407500/01/02

References
Please indicate at least two persons within your home institution who will provide references for your application
Reference 1 :
Name 1 HAGOS WOLDEGHEBRIEL(Ph.D)
Position 1 Assistant Professor of Physics, Library and ICT Director of Mekelle
University
Address 1 P.O.Box: 231 Mekelle University Main Campus, Mekelle, Ethiopia
Phone number 1 +251914788635
Fax 1 +251344409304
Email 1 hagos93@yahoo.com
Website 1
Reference 2 :
Name 2 SIB KRISHNA GHOSHAL (Ph.D)
Position 2 Associate Professor
Address 2 P.O.Box: 1176 Addis Ababa University Faculty of Science
Department of Physics, Addis Ababa, Ethiopa
Phone number 2 +251910351858
Fax 2 +251911223931
Email 2 lordshib@gmail.com
Website 2
Reference 3 (optional):
Name 3 K.K NARAYANAN (Ph.D)
Position 3 Assistant Professor of Physics
Address 3 ALAPPUZHA-3, KERALA; INDIA, SENIOR LECTURER IN
PHYSICS, SANATANA DHARMA COLLEGE (UNDER UNIVERSITY
OF KERALA)
Phone number 3 +919446043648 (Mobile)
Fax 3
Email 3 narayan01@fastmail.fm

EMMC application form 1/3

 The information in this application form is dedicated to the candidates selection to the EUROPHOTONICS Master program,
and shall not be shared with others for any other purpose
Website 3

Have you visited one of the institutions NO

of the Europhotonics master program ?
If yes, dates of your visits, name of the visited place

Educational Background
All education mentioned below should be proven by official documents
Title of the diploma 1 : MASTER OF SCIENCE IN PHYSICS
(most recent first)
Degree obtained or expected (BsC, MsC, …) 1 M.Sc.
Date of the obtained diploma 1 August 23, 2007
Grade / Score obtained in % (ex : 12/20 =60%) 1 3.50/4.00= 87.5%
Name of the Institution / University 1 ADDIS ABABA UNIVERSITY
City 1 ADDIS ABABA
Phone number / Fax 1 PHONE:+25111223931 FAX: +25111223931
Title of the diploma 2 : BACHELOR OF EDUCATION IN PHYSICS
Degree obtained or expected (BsC, MsC, …) 2 B.Ed.
Date of the obtained diploma 2 JULY 16, 2005
Grade / Score obtained in % (ex : 12/20 =60%) 2 3.29/4.00= 82.25%
Name of the Institution / University 2 MEKELLE UNIVERSITY
City 2 MEKELLE
Phone number / Fax 2 PHONE:+251344407500/01/02 FAX: +251344405949
Title of the diploma 3 :
Degree obtained or expected (BsC, MsC, …) 3
Date of the obtained diploma 3
Grade / Score obtained in % (ex : 12/20 =60%) 3
Name of the Institution / University 3
City 3
Phone number / Fax 3

Languages knowledge*
English level * 2

English score of test ** (TOEFL, IELTS, OTHERS) if I have received my B.Ed. Degree and M.Sc. Degree in Physics from
relevant Mekelle and Addis Ababa University respectively, where English was
the Medium of instruction
Other language 2 (please indicate)
Level language 2
Other language 2 score of test
Other language 3 (please indicate)
Level language 3
Other language 3 score of test

Publications
including thesis, project work, … please use only 1 excel I work my M.Sc. Thesis in the area of theoretical condensed matter
line Physics on “ Structural Transition in Layered High Temperature
Superconductor (YBCO)”

Professional experience
Employer or Employing Institution 1 (most recent first)
Address 1 P.O.Box:231 Mekelle University Main Campus, Mekelle, Ethiopia
Title of function 1 University Lecturer
Description of function 1 At present I am teaching undergraduate students as well as doing
research in the capacity of the department of Physics
Duration (from…. to… ) 1 From September 1, 2007 to November 19, 2010
Name, Telephone and Email of direct supervisor Alem Mebrahtu(PhD); Assistant Professor in Physics; Dean of
College of Natural and Computational Sciences
Department of Physics
P.O.Box:3044 Mekelle University Main Campus Mobile Phone:
+251914753502 E-
mail:alemmeb@googlemail.com
Employer or Employing Institution 2
Address 2
Title of function 2

EMMC application form 2/3

 The information in this application form is dedicated to the candidates selection to the EUROPHOTONICS Master program,
and shall not be shared with others for any other purpose
Description of function 2
Duration (from…. to… ) 2
Name, Telephone and Email of direct supervisor 2
Employer or Employing Institution 3
Address 3
Title of function 3
Description of function 3
Duration (from…. to… ) 3
Name, Telephone and Email of direct supervisor 3

Place of choice for the master 3rd semester

(1 : most favored / 3 : less favored) - this choice is only an indication that can be changed during the 1st year of the master program
Marseille, France 3
Karlsruhe, Germany 1
Barcelona, Spain 2

Declaration of candidature
Do you apply to the EMMC fellowship ? YES
Are you a citizen from a third-country * ?
YES

Do you apply to another EMMC fellowship than NO

EUROPHOTONICS ?
For third-countries candidates to the EMMC fellowship :
I hereby declare that I am not a citizen, a resident and
have not carried out my main activities (studies, work, etc.)
for more than a total of 12 months over the last five years YES
in any of the 27 EU Member countries and the EEA-EFTA
states (Iceland, Liechtenstein and Norway).
For all candidates :
I hereby certify that the information in this application form
is accurate and complete (including all supplements). I
understand that failure to disclose correct, complete and YES
legible information may result in the cancellation of my
application or admission.

Date, place : November 19, 2010, Mekelle

Signature (write first name and family name):

ASHENAFI WELDEMARIAM GEBREGIORGIS

This application form is one of the documents that you will have to upload (in excel formal) on :

http://www.europhotonics/emundus/

Deadline and information : see the page

http://www.europhotonics.org/wordpress/master/future-students/master-application-procedure

EMMC application form 3/3