Application Form
COMSTECH- Mauritania S &T Cooperation Program
Email-1
example@example.com
Submission Date
-
Day
-
Month
Year
1- Full Name
*
Full Name, as per passport
2- Nationality
*
3- Current Country of Residence
*
4- Religion
*
5- Email
*
example@example.com
6- Date of birth
*
-
Day
-
Month
Year
7- Passport number
*
8- Expiry Date (Passport)
*
-
Day
-
Month
Year
9- Marital status
*
Please Select
Single
Married
Divorced
Widowed
10- Number of children (if any)
*
11- Current address
*
12a- Details of education (Please state your Highest degree, institution, grade),
*
12b- Upload clear scan of degree / transcript
*
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of
13- Details of any previous visits abroad
*
0/100
14- Proof of English language proficiency (tick the relevant)
*
Please Select
Not Proficient
Average
Proficient
15a- Medical fitness
*
*Declare any medical condition you have (this will not affect the outcome of your application.
15b- Medical fitness
*
*Declare if you or your partner are expecting a child.
16- Current/previous employment
*
*Name of the organization/employer and your Job description
17- Why do you want to avail this fellowship/training program and why are you a good fit? (at least 200 words)
*
0/200
18- What are your research/training objectives? Please write details of the research/training you wish to conduct (at least 200 words)
*
0/200
19- Please list up to two preferred institutions from the CCoE member institutions (link below). While we will take your preferences into consideration, please note that there is no guarantee of placement in these specific institutions.
*
0/50
*For CCoE Member institutions list, Click here
https://comstech.org/list-of-ccoe-members-1/
20- Scan of one recommendation letter (current/most recent Institution)
*
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The file should be in .pdf or .jpg format only. File size must not exceed 300kb
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of
21- Upload Clear scan of passport
*
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The file should be in .pdf or .jpg format only. File size must not exceed 300kb
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of
22- A detailed CV enlisting all educational/professional activities, research publications and a clear picture, from not more than 6 months ago.
*
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The file should be in .pdf format only. File size must not exceed 500kb
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of
Declaration
*
By signing this form, you acknowledge that all the information provided is true, and agree to comply with all terms and conditions of this fellowship.
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