EMBASSY OF FRANCE IN SOUTH AFRICA Application Form for PhD Grants 2018 Required documents (to accompany this form): 1. Fully completed and signed application form 2. Certified copy of valid passport 3. Certified copies of all degree certificates and academic transcripts (both for complete and incomplete qualifications) 4. Motivation letter (no longer than two pages) 5. Curriculum vitae (no longer than two pages) 6. Outline of research project (no longer than two pages) 7. Supporting letter from supervisor in South Africa 8. Supporting letter from supervisor in France 9. Copy of the co-tutelle agreement between the South African and French university E-mail the complete application folder (9 attachments in PDF format only) to pretoria.bourses@campusfrance.org Please note that there is no deadline and applications are accepted throughout the year. See the accompanying PhD grant information document. 1. PERSONAL DETAILS Surname (as it appears in your passport) First name(s) (as it appears in your passport) Sex (mark with X) Male Female Nationality (please inform in case of dual nationality) Date of birth (dd/mm/yyyy) Place (city) of birth Country of birth Marital status (mark with X) Single Married / Civil Union Other Page 1 of 6
2. CONTACT DETAILS Cellphone number E-mail address Next of kin telephone number to be used when you are in France Residential address: Street Residential area City Postal code 3. SECONDARY SCHOOL EDUCATION Name of school City, Province Attended from (mm/yyyy) to (mm/yyyy) Date of receipt of senior certificate Page 2 of 6
4. HIGHER / TERTIARY EDUCATION (University or degree-awarding institution) Please state your qualifications obtained in chronological order (from first to last) and attach certificates and transcripts in the same order. University Attended from year (i.e. 2001) Year completed (state if incomplete or year to be completed, in latter case attach proof of registration ) Degree / Diploma (as appears on certificate or proof of registration) Major subjects Page 3 of 6
5. RESEARCH PROGRAM IN FRANCE Institution / Doctoral school Full title of PhD (if relevant) Specialization (if relevant) Have you established a co-tutelle agreement between this institution and your current institution / university in South Africa, and have you thereby initiated the enrolment process at this institution? Name, surname: Position / Job Title: Contact person (i.e. co-supervisor): E-mail: Why have you chosen this particular programme and institution (i.e. how does this institution / programme meet your research objectives)? 6. LANGUAGE SKILLS Have you ever taken French language classes? (note that you do not need any prior French language learning to apply for this scholarship, this is purely for informational purposes) Since when? Where? Other languages Page 4 of 6
7. PREVIOUS VISITS ABROAD (visit, work, study) Country / City From To Purpose of visit (vacation, work, study, etc.) 8. PRACTICAL OR WORK EXPERIENCE (DURING STUDIES OR POST-QUALIFICATION) Company / Organisation City / Country From To Position (Title) 9. CAREER EXPECTATIONS What professional career do you envisage? In your opinion, how will your studies in France support your future career? Page 5 of 6
10. FINANCIAL ASSISTANCE Have you received a scholarship from the French government before? Have you received any other international scholarship before? Are you currently applying for any other scholarship? Do you have any other sources of funding available to support your stay in France? (Please note that partial bursaries may also be awarded to allow for as many students as possible to obtain funding. If a student is able to obtain additional funding and declares this openly and honestly, it may improve the student s chances of obtaining funding through this program). Co-funding from private companies are particularly welcome. If please state the year and program If please state the year and program If please state the year and program Please state estimated amount (in Rand) Please state source (personal savings, parents, loan, etc.) DECLARATION I, the undersigned (SURNAME, Name) commit myself to the general conditions of the bursary and to be willing to declare all supplementary documentation that would facilitate the evaluation of my application. I affirm the information contained herein and hereto attached to be true and correct to the best of my knowledge. Signed at (place) on (date) Signature Page 6 of 6