Current status (educational or professional)
Do you study or work? Student Employed Other
Where do you study/work? (University, faculty, group No./ place of work)
Principal degree or diploma (held or currently being taken)
Specialization
4. Address
Permanent address: country____ city ______ ZIP code
Street __ _______ house ___ block ___ flat ___
el ________ E-MAIL ________
Financing
What sources of financing do you plan to call on for your education?
Company/Organization Please give details
Own resources Other
Is this financing: already assured under discussion
General
1. Foreign language proficiency
Language Level Diploma / certificate
2. What cultural, sports and community activities did you participate in (or are participating in) and what other interests do you have?
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3. Have you held a position of responsibility? Give details.
4. Any additional information about yourself.
5. Why have you chosen this program? What type of career are you aiming at?
Referees
Names and addresses of your referees (only for not Gubkin University applicants)
| Name Position Company/Organization/University Tel. No. Fax E-mail | Name Position Company/Organization/University Tel. No. Fax E-mail |
8. Additionally:
EDUCATIONAL HISTORY, including current studies and complementary non-qualifying studies (starting with current or last year of study)
Year; University/Engineering School _______________________________________________
Qualification (credit, option)______________ Average GPA________ Ranking_______
I certify that to the best of my knowledge the facts stated on this form are correct and agree that my personal data will be processed according to the Russian Federal law.
Date_______________ and signature ______________________________________
Notes on Completing the Application Form
Please, fill in the application form in Russian and in English (Gubkin University applicants are to submit the questionnaire by-email and on paper).
The information requested is treated as confidential, in accordance with Russian Federation law. The information is kept until the start of the academic year. The application form and the accompanying documents remain the property of Gubkin University.
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