Sheikh Mohammed Bin Zayed Program for Postgraduate Studies

Buhooth Application Form

A. Personal and Contact Details

Name of Applicant *

Title ( Mr. /Mrs...etc)

First

Middle

Surname

Date of Birth *

Marital Status *

Country of Birth *

Nationality *

Contact Address *

Telephone *

Fax

Mobile *

e-mail *

B. Qualifications (already obtained or expected, please attach supporting documents) * (at least one record is required)

Title of Qualification /Certificate

Awarding Body/ University

Dates of Study

GPA/Average/

Classification

From

To

C. Work Experience (recent principal appointments, please provide a Curriculum Vitae)

Organisation

Dates

Post Held

From

To

D. English Language Proficiency (please provide copies of certificates)

First language

Please give details of any relevant qualifications in English language (e.g. TOEFL date and score).

Type (TOEFL/IELTS)

Score

Exam Date

E. Program (please select the program that you wish to apply to) *

M.Sc. By Research

Ph.D. in Engineering

F. Proposed Research

Proposed Specialization

(Please select one) *

Electronics Eng.

Communication Eng.

Computer Eng.

Title of Proposed Research

Proposed Start Date

Short Description of Proposed Research Topic

Please use additional pages if required.

G. Referees (please send the appropriate referee forms to your nominated referees)

First Referee

Second Referee

Third Referee

Name *

Position

Organisation

Address

Telephone

Mobile

Fax

E-mail *

H. Additional Information (if you wish to give additional information use this section)

All decisions by the Buhooth Program are taken in good faith on the basis of the statements on your application form. If the Buhooth Program discovers that you have made a false statement or have omitted significant information on your application form, it may withdraw its offer, or terminate your registration.