MARTIN-LUTHER-UNIVERSITT

HALLE-WITTENBERG
Naturwissenschaftliche Fakultt II

Master course Polymer Materials Science

Application for Admission
winter semester 20__/__

1. Personal information
First name: ..........................................................................................................................................
Last name: .......................................................................................................................................
Highest academic degree: ...........................................................................................................
Sex:

male

female

Nationality: .........................................................................................................................................
Date, place of birth: ....................................................................................................................
Marital status and number of children: ...............................................................................................
2. Mailing address
c/o: ......................................................................................................................................................
Street, house number: ..........................................................................................................................
Postal code: ........................................................................................................................................
City, country: ......................................................................................................................................
Telephone number: .............................................................................................................................
E-mail: ................................................................................................................................................
3. Home Address
Street, house number: .........................................................................................................................
Postal code: .........................................................................................................................................
City, country: ..............................................................................................................................
Telephone number: .............................................................................................................................
E-mail: .................................................................................................................................................

4. Primary and secondary education

Please describe briefly your primary and secondary education .........................................................................
...............
...
..
..
5. Higher education
At which colleges/universities have you studied and which degrees have you obtained?
Country

Name and location of

college/ university

Subject

Duration

Degree

from until

achieved

Result/ Grade

Please verify your information by enclosing all relevant documents as officially certified copies.
Do not send originals.

6. Language skills

Describe your English skills: ...........................................................................................................

..................
For non-native speakers:
Where did you study/learn English? ..............................................................................................................
For how long? ....................................................................................................................................................
Do you have certified proficiency in English? ...........
If yes, please provide details: .....................................
.................
Have you taken the TOEFL-Test? ...................................................................................................................
If yes, what score did you obtain? .....................................................................................................................
Describe your German skills: ...............................................................................................................
...........
For non-native speakers:
Where did you learn/study German? ....................................................................................
For how long? ...................................................................................................................................................
Do you have certified proficiency in German? .....................................................................
If so, please provide details: ....................................................................................
.........................
Please enclose proof of your language skills (TOEFL-certificate, UNIcert II).

7. Curriculum Vitae

Please provide a brief chronological overview of your educational and professional experience.
Time
from until

9. Signature
I hereby verify that all given information is complete and accurate. All documents required are enclosed. I am
aware that providing false or incomplete information intentionally may lead to rejection of my application, or
if discovered after admission, to the revocation of my admission.

..................................................
Location, Date,

....................................................
Signature

The information enclosed is protected by regulations of data privacy.