APPLICATION FOR ADMISSION FOR FOREIGN Not to be filled in by the applicant! APPLICANTS: Eingangsdatum Semester: WS 2016/17 Campus Duisburg Bewerber-ID: 120626 jease observe the application deadines! Antrags-Nr: 201621860 T November- 15 January forthe following summer semester (tats n Aer) HZB 0 Jao nein May. 18 ly ‘orthe following winter semester (statsin October) Art Fach: Note: Datum: 1, DESIRED DEGREE COURSE 1.1 Ast choice degree course Major subject Embedded Sys. Engineering Specialisation Target degree 1st minor subject 2nd minor subject: Master of Science 1.2 2nd choice degree course Major subject Autom. Control Engineering Specialisation Target degree 1st minor subject 2nd minor subject: Master of Science 2. PERSONAL DETAILS Family name: Patel First name: Mayur Vallabhbhai () Date of bith: 08.09.1861 Place of birth: Indien Nationality Indien 3. ADDRESS clo: c\o Pranav Barot Street: Duisburgerstr. 445 Supplements: zimmer 116 Postcode: 45478, city: malhein Country Deutschland Telephone: +4817641998927 Mall mayurpatel.gecQgmail.com © Erststudium © Aufbaustudium © Zweitstudium ‘© Promotion Feststellungsprif: 6 ja © nain Studienkolleg: -Kurs APS: Fs. © PA am Ne: Deutschkenntnisse Gesamtstundenzahi Niveau: © DSH erforderlich © DSH nicht erforderiich © DSH liegt vor Englischkenntniss= © austeichend © TOEFL, © IELTS © Nachreichung angefordert Frist © Ablehnung Zugangsbescheld Prifungsergebnis © Sprachkurs oT ou © DSH OB onB okt © Fachstudium © Erasmus4. YOUR EDUCATIONAL BACKGROUND (tach your certfeatesin al) ‘Al deta must be proven by copies ofthe orginal documents (eg. school leaving certates, records of study, transcripts, eto.) and German or English tanslaons. The aforementioned documents have to be attached to this application form. Please be aware that we cannot process your application without complete documentation orit any detals are missing CURRICULUM VITAE Edueation!taicing Duration Dells: rame, location and country of edurational institution School edueation since 2012 Mae. Elecerical comps Electronics Powercamp: automation) , Uni Period ofchookng r00s-r0u7 B.tngg. Electronics camp: Communication , Gujarat Technologic: (Primarylelementary school tothe 2008-2007 High School, Jeevan Bharti , Surat, GajaratyIndis fend ofschooing) asst-2007 Primary Sebool Jeevan Bharti, Surat, Gujarat, India Which schoolleaingcetfeate Date Otiginal name: g.baccalauréat, Lise diplomas: Maturitt id you obtain? ren BacheLozc#025:3 Degree Country: Inaten [id youtake an entrance ves Name ‘qualfeaion exam fer higher Month/Year: / 2017 GATE: $0/i20(In@ia) education inthe counryin which ypu dd the schooling? Have you ever studied in M.se. Elecerical comps subjects: non Linear control, modern control, Germany andlor ina ‘reign n modelling and simulation, Theory of Stochastic country? Hignals, Tmerical maths, ves Subjects, examinations, degrees Studenkoleg Date ofassessmenttest Name and place ofthe Studienkolleg Course ous (reparatoryfoundation course) id you attend a Studienkallegin Germany or take the assessment test (Fesstelungspriting)? Ccuriulum Vitae Hines toL2-ege: Msc. EEE(University Of Duisburg-Essen) r00s-202 BLE. Elecerontes comps Communieation(€TU, India) Prakeilnm: Advanced Enhedded Systems (BRACS, Indi)5. LANGUAGE PROFICIENCY (tach your certfates in ul) 54 Command. German Have you evertahen lessonsin German? YES Which level? Basie: Intermediate: BE Hours in toa Fullname ofthe cetifeate awarded Bt eerttinst A¥wbichinsttaton? LANES Date awarded: 90.04.2035, Where? Doisburg, Gemmany Have youtakenthe TestDaF? no ‘Are you curenty attending @ German language course? m0 5.2 Which other language skills do you possess? English Degree Courses: TELTS Soore: ea 6. APPLICATION FOR ADMISSION TO A LANGUAGE COURSE Do you wish o apply fr admission to 2 German language course? De Kosten hierfir werden von den am Markt tigen Sprachschulen direkt ethoben. Diese Sprachschulen legen auch dle Zumelsung fir eine Korsstute fet. Das Fachstudium kann erst nach erblgreich abgelegter Deutschprifung (OSH) autyenormmen werden! 7. OTHER QUESTIONS Student support: Have you been awarded 2 grant? me From which inststion? Other sources of founding (voluntary answer) ‘ce you partcipating in any student exchange programme wih our university? no Which programme? Home universty 8. OTHER APPLICATIONS Have you ever applied to Duisburg-Essen Uriversty before? YES Campus Detsburg: W.Se Power camps Aveamstion(EEE) Please name all other German higher education insttuons youhave appledintand to appt9. PREVIOUS UNIVERSITY EDUCATION IN GERMANY Have you ever studied in Germany? ves Complete name ofcolege(s)iniversiy(les): University of Dutsburg-Easen Wherein Germany? Doi shurg Semester of frst encolment ws 2012 Which course(s) id you study in Germany? W.Se EEE (Power camps Automation) Ifyou have already studied in Germany which semester are youlwere you in? Semesters in otal: € ‘Subj-tlated sem: € Semesters on leave: Period (in semesters) uthout studying Depress: 2.1/5.6 10. INFORMATION ABOUT THE STUDIENKOLLEG ‘The Studienkolleg ofers foundation courses for freign students as preparation fr studying in Germany in cases where the school leaving cerfeate is not recognised in Germany. Sudienkoleg courses Srish wth the assessment test (Feststllngsprifing). border tobe admted to Stusfenkaleg ypu have to take an entrance test (Auhhahmeprifing) Duisburg-Essen Universty doesnot ofera Studienkolleg. You need to applytothe Studenkoleg rectly Studenkoleg. Benksreplerung Disseldort Postfach 20 80 65, - 40408 Disseldort Tel:+40(02110876-0, Fax: +40(03211475-5078 ‘The application dealin are 15 May forthe folloing winter semester and 31 October forthe following summer semester. IMPORTANT NOTES \We can only process your application it suffcient and precise information is given. the frmis signed and al required documents ae enclosed! | conte that to the best of my knowledge and belie all the information Ihave given on this form iste, complete and accurate. The required documents (copes of schol leaving cerifcates. records of study, proof, transept, et.) are enclosed. For Chinese applicants: The original of the {APS-cetifeate has tobe submited | accept fl responsbilty forthe completeness ofmy application and keeping my details upto date (e.g. addresses). |/am aware that intentionally or neghgenty ging false information constitutes an adrinisrative offence and may lead to excision for the adeissions procedure orf discovered at later dat -to the cancellation of my adission or enolemert. Giving false information in the said manner ‘an resutin the excision fom universty study. leertfythatno ther unverstyin Germanyhas ever excluded me fom studying. Furthermore, lar that Id nat timate fall any examination that is stipulated by the respective examination rules ofan insti of higher eduction in Germany, agree to the storage and processing of my data by Duisburg-Essen Universty. They are fly covered bythe data protection regulations current in fore. lam aware that my documents ull not be stored for longer than one semester if | do not enol at Duisburg-Essen University inthe semester | requested or i do not reply to any queries fom the Universty within two months. in ether ofthese cases my records and documents ull be destroyed uthin a year on March 31 or September 30. Under certain circumstances students have to pay study fees in Nort Rhine-Wesiphala. Mere information can be obtained on the intemet: Inipta a uni-due.defntematonallen_studyees she | declare that Ihave rea the Leatet onthe Applicaton Form fr Admission to Studies andthe enrolment regulations. Place Dae Signature