Royal University of Phnom Penh Masters of Science in Biodiversity Conservation

Transcription

1 Attach Photos Here 4 x 6 cm Royal University of Phnom Penh Masters of Science in Biodiversity Conservation To apply for the Masters of Science in Biodiversity Conservation programme, please enclose the following documents and forward them by 26 th September 2014 to the:- Centre for Biodiversity Conservation (CBC) Room 415, Building A, Royal University of Phnom Penh, Faculty of Science, Confederation of Russia Boulevard, Phnom Penh. One completed application form (this document) Three 4x6 cm and two 3x4 cm photographs against a white background Bachelor degree certificate, certified by the Phnom Penh Municipality An indication of proficiency in spoken and written English (recent qualifications only) Certificate of Employment (if required) Application Form 1. Personal Information Name: English Khmer Sex: Male Female Date of Birth: Day Month Year Marital status: Single Married Current Contact Address: Tel:

2 Please also give your home address below (if different from the above): Home Address: 2. Academic information Please list in date order all colleges and universities attended Year Degree Obtained Majors/Field Institution Language of Instruction English proficiency: Speaking Excellent Good Fair Writing Excellent Good Fair Reading Excellent Good Fair 3. Work experience (if applicable*) Please list three of your previous work positions including your most recent (or current) job title. Please include any volunteer or unpaid work (if any) that you may have undertaken. * Please leave this section blank if you are a recent graduate or have yet to work in full time employment. # From To Organization / Company Title of position 1 2 3

3 Current Employer s Name: Address: Tel: Fax: 4. Parent information Fathers Name (Khmer) (English) Date of Birth: Day Month Year Nationality: Dead or alive Occupation/Place Mothers Name (Khmer) (English) Date of Birth: Day Month Year Nationality: Dead or alive Occupation/Place 5. Other Information Please fill in the following sections below and include any information related to biological and environmental sciences and field research (If there is not enough room in the boxes provided, please attach additional sheets to this form) Present duties and responsibilities for current employer (If applicable*): * Please leave this section blank if you are a recent graduate or have yet to work in full time employment.

4 Training courses undertaken: Research/ Publications/ Awards: Please state how you first learnt about the Biodiversity Conservation Masters programme Applicant Declaration I hereby confirm that all of the information in this application form is entirely true to the best of my knowledge and that I take sole responsibility for its accuracy. Signature: Date: Please submit all completed application forms and relevant documents to: Centre for Biodiversity Conservation (CBC) Room 415, Building A, Royal University of Phnom Penh, Faculty of Science, Confederation of Russia Boulevard, Phnom Penh. Closing date for applications: 26 th of September 2014

5 Application form Bridging Course Attach Photos Here 4 x 6 cm 1. Personal Information Name: English Khmer Sex : Male Female Date of Birth: Day Month Year Marital status: Single Married Current Contact Address: Tel: 2. Education Record Name of institute: Field of study: Date (from-to) - Degree/diploma awarded: 3. Background 3.1 Some short courses require knowledge of statistical analysis I have undertaken statistics training I have only a basic awareness of statistics I have no experience with statistics 3.2 Some short courses require knowledge of biodiversity, ecosystems and the environment I have undertaken biodiversity/ecosystem/ environmental training I have only a basic awareness of biodiversity/ecosystem/ environment I have no experience with biodiversity/ecosystem/ environment 3.3 Some short courses require knowledge of the English language I have undertaken English language training I have only a basic awareness of English I have no experience with English 4. Undersigned Signature: Date:

6 ក រស ងអប រ យ វជនន ងរ ឡ ស រលវ ទ យ ល យភ ម នទភន ព ញ ល ខបញ ជ... ល ខបន ទប...ល ខត... បង ក ន ដ ទទ លព ក យស ប រលងច លស ក ផ ន ក វ ទ ស ស រសតអភ រក សជ វ ច រ ជ ន ន ទ ១០ ន មត តក ន ងន មខល ន...ជ អកសរឡ ត ង... ល ទ... ថ ង ខខឆ ន ក ល ត ថ ង ទ...ខខ...ឆ ន... ទ កខន លងក ល ត ឃ /សង ក ត...ស ស ក/ខ ឌ...លខតដ/ត ក ង... កត ម តជ ន ញ... ម ខរបរសព វថ ង... លបកខជន មកព អងគភ ព... រ បងត ៤ x ៦ សម យត បឡង...ម ឌ ត បឡង... រ ជធ ន ន លព ញ. ថ ង ទ ខខ ឆ ន ២០... អនកទទ ព កយ ហតថល ខ ន ង ល ម ល វ ល...ថ ង ទ... ខខ... ឆ ន ២០... ហតថល ខ ន ងល ម លបកខជន ក ត ច ណ -លបកខជន ត ត វបង ត ក ច ន ន ១០ដ ល លល អ លមរ កស រ ប ស ទឋ ត ប ង -លបកខជន ត ត វបង ក ញបង ក ន ថ ដលន កន ងលព ត ប ងជ ដ ច ខ ត -លបកខជន ត ត វរក ទ កបង ក ន ថ ដលន ស រ ប ដកស ខ តវ ញលត យលព ត ប ងធ ល ក លដ យម ន លអ យហ សរយ លព ព រខខ(២ខខ) លត យថ ង ត ប ស ទឋផ ច ងលត យ ក រស ងអប រ យ វជនន ងរ ឡ ស រលវ ទ យ ល យភ ម នទភន ព ញ ល ខបញ ជ... ល ខបន ទប...ល ខត... បង ក ន ដ ទទ លព ក យស ប រលងច លស ក ផ ន ក វ ទ ស ស រសតអភ រក សជ វ ច រ ជ ន ន ទ ១០ ន មត តក ន ងន មខល ន...អកសរឡ ត ង... ល ទ... ថ ង ខខឆ ន ក ល ត ថ ង ទ...ខខ...ឆ ន... ទ កខន លងក ល ត ឃ /សង ក ត...ស ស ក/ខ ឌ...លខតដ/ត ក ង... កត ម តជ ន ញ... ម ខរបរសព វថ ង... លបកខជន មកព អងគភ ព... រ បងត ៤ x ៦ សម យត បឡង...ម ឌ ត បឡង... រ ជធ ន ន លព ញ ថ ង ទ ខខ ឆ ន ២០... អនកទទ ព កយ ហតថល ខ ន ង ល ម ល វ ល...ថ ង ទ... ខខ... ឆ ន ២០... ហតថល ខ ន ងល ម លបកខជន ក ត ច ណ -លបកខជន ត ត វបង ត ក ច ន ន ១០ដ ល លល អ លមរ កស រ ប ស ទឋ ត ប ង -លបកខជន ត ត វបង ក ញបង ក ន ថ ដលន កន ងលព ត ប ងជ ដ ច ខ ត -លបកខជន ត ត វរក ទ កបង ក ន ថ ដលន ស រ ប ដកស ខ តវ ញលត យលព ត ប ងធ ល ក លដ យម ន លអ យហ សរយ លព ព រខខ(២ខខ) លត យថ ង ត ប ស ទឋផ ច ងលត យ