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APPLICATION FORM

Erasmus University Ph.D. Program on Cleaner Production, Cleaner


Products, Industrial Ecology & Sustainability 2009-2010
General Information

Last or family name: ............................................................................................................................................


First or given names: ............................................................................................................................................
Gender: male female Date of birth: year ................month.......................day................
Marital Status: single married
Citizenship: .............................................................. Country of residence: ........................................................
Home address........................................................................................................................................................
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Telephone: ............................................................. Telefax: ................................................................................
Work address: ......................................................................................................................................................
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Telephone: ............................................................. Telefax: ................................................................................
E-mail: .................................................................................................................................................................

Financial Support
I have already obtained sources of funding to cover all expenses in connection with my participation in the
Ph.D. Program. The money at my disposal amounts to: ............. and comes from the following sources:
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I have applied / I intend to apply for financial support, and I will know before the start of the program
whether I will receive financial support. I anticipate obtaining approximately: ............. from the following
sources:
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Education (B.Sc. & M.Sc.)

B.Sc. Degree title in original language: ...............................................................................................................


B.Sc. Degree title in English: ...............................................................................................................................
From (university or college): ...............................................................................................................................
Date enrolled: ................................. Date completed:.....................................
Description (main subjects): ................................................................................................................................
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M.Sc. Degree title in original language: ..............................................................................................................
M.Sc. Degree title in English: ..............................................................................................................................
From (university or college): ...............................................................................................................................
Date enrolled: ................................ Date completed: ......................................
Description (main subjects): ................................................................................................................................
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Enclose certified copies of your diplomas and transcripts with your application

Education (other relevant)

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Publications (scientific papers, articles, etc.)

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Employment (over the last 10 years)

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NAME OF APPLICANT ...........................................................................................................................................


English language skills
English is my mother tongue
I have the following capability in English:
Reading poor fair good very good excellent
Conversation poor fair good very good excellent
Writing poor fair good very good excellent

Other languages in which I have skills: ................................................................................................................


Reading poor fair good very good excellent
Conversation poor fair good very good excellent
Writing poor fair good very good
excellent

Letters of recommendation (name, address, telephone)

1. ..........................................................................................................................................................................
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2. ..........................................................................................................................................................................
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3. ..........................................................................................................................................................................
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Additional question
How did you find out about the International Ph.D. Program? ............................................................................
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NAME OF APPLICANT: .........................................................................................................................................


Agreement

I hereby confirm that the information provided in this application and its enclosures is true and complete. I am
aware that I can be removed from the Ph.D. Program at a later date if information provided in this application
proves to be incorrect or false.
By signing below I indicate that I understand that acceptance into the Ph.D. Program entails no obligation on
the part of the Erasmus Centre for Sustainable Development and Management or the Erasmus University
Rotterdam, to financially support, in any way, my participation in the program. I understand that I am
responsible for finding an academic co-advisor at a university in my local region. Furthermore, I am aware
that the responsibility to obtain the necessary visa or residence permits for my participation in the annual
intensive courses and completion of my Ph.D., is entirely my own.

Signature: .............................................................................................................................................................
Name of applicant: ...............................................................................................................................................
Date and place: ....................................................................................................................................................

To be filled in by employer:

I support my employee's participation in Erasmus University's International Ph.D. Program on Cleaner


Production, Cleaner Products, Industrial Ecology & Sustainability.
I will ensure that he/she is available for ........ hours a week to work on his/her Ph.D. study.

Signature: .............................................................................................................................................................
Name: ...................................................................................................................................................................
Date and place: ....................................................................................................................................................

Enclosures

Send your complete application to:


Erasmus centre for Sustainability and Management (ESM)
Erasmus University Rotterdam
International Off-Campus Ph.D. Program on Cleaner Production, Cleaner Products, Industrial Ecology &
Sustainability
P.O. Box 1738
3000 DR Rotterdam
The Netherlands
Phone: +31.10.4082050
Fax: +31.10.4089104
E-mail: degroot@fsw.eur.nl

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