Ua-uk student Experience Programme Application Form Application deadline is 8 June 2014 icon

Ua-uk student Experience Programme Application Form Application deadline is 8 June 2014


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UA-UK Student Experience Programme

Application Form


Application deadline is 8 June 2014.

Completed applications should be sent to Ukrainian Professionals in London via email: sep.ua.uk@gmail.com

Certain applicants will be selected by June 23rd to proceed to Skype interviews during the week of June 23-30. Applicants will be informed of their status by phone or email.

Please complete this form electronically by typing your responses in the boxes provided or in a separate document. Legibly handwritten responses in black ink will also be accepted. Your answers in each section should not exceed 1,000 words. We prefer that responses are provided in English but may consider outstanding responses in Ukrainian or Russian.

Information provided in this form should be accurate and complete. We reserve the right to disqualify candidates whose applications are similar to those of other candidates or otherwise at our discretion.

Completion of this form does not guarantee any candidate acceptance into the Programme. Each Participant is solely responsible for meeting the relevant eligibility and entry/exit requirements for the countries involved and compliance with all applicable laws.


^ SECTION I: Define yourself and the world around you. (In your responses, please consider what inspires you, what is important to you, and above all, how you can effect real change in society? Use whatever format would allow you to best express yourself.)

  1. What has had the greatest influence on your thinking and personal beliefs?




  1. What is the greatest invention, innovation or idea of all time?




  1. If there was one thing you would like to be remembered for, what would it be?




  1. How would your friends, colleagues, and family describe you?




  1. What is most regrettable about our world today?




  1. What would you like your generation to be remembered for?




  1. What personal accomplishment(s) are you most proud of?






SECTION II: Your interest in the Student Experience Programme

  1. Briefly, why do you wish to participate in the Programme?




  1. What are the main subjects you would like to explore during the Programme?




  1. How can the information and insights gained during the Programme help you upon your return to Ukraine?




  1. Do you already have a particular project or idea that you are developing (or plan to initiate) in Ukraine?






frame1

^ SECTION III: Tell us the basics

Name:

(in Ukrainian)

(in English as per your foreign passport)

Age:

Postal address:

E-mail address:

Telephone number:

Mobile phone number:

Skype number:


Website/blog address (if any):





^ SECTION IV: Education

University:

Year of study:

Specialisation:

Educational achievements:


Study abroad programs (if any):

Level of English language ability:




^ SECTION V: Other (please provide any other relevant information that you think better describes you, your achievements and can support your application)





Please provide contact information for two recommenders - one should be from your university.


Recommendation #1:

Recommender’s name:

Relationship to applicant (professor, manager, etc.)

Email address:

Mobile phone number:



Recommendation #2:

Recommender’s name:

Relationship to applicant (professor, manager, etc.)

Email address:

Mobile phone number:



I, the undersigned, certify that to the best of my knowledge and beliefs, the data and statements above correctly describe me, my qualifications, experience and aspirations:


Signature: Date:

^ Please also review and sign the waiver on personal data information provided below.


ЗГОДА

на обробку персональних даних


Відповідно до закону України «Про захист персональних даних» від 01.06.2010 № 2297-VI,

я,


__________________________________________________________________________________,

(прізвище, ім'я та по-батькові кандидата повністю )


даю згоду на обробку моїх персональних даних з використанням засобів автоматизації або без використання таких засобів з метою здійснення та обліку результатів виконання Програми на основі використання сучасних інформаційних і комунікаційних технологій.


Я надаю право здійснювати наступні дії (операції) з моїми персональними даними: збір, систематизацію, накопичення, зберігання, уточнення (оновлення, зміну, використання, знеособлення, блокування, знищення) уповноваженим представникам, а також особам та організаціям, з використанням засобів автоматизації або без використання таких засобів з метою здійснення та обліку результатів виконання Програми на основі використання сучасних інформаційних і комунікаційних технологій право на збір і обробку моїх персональних даних, а саме:


  1. прізвище, ім'я, по батькові

  2. рік, місяць, дата народження

  3. соціальне становище

  4. освіта

  5. місце проживання

  6. контактна інформація

  7. паспортні дані


Я надаю право організаторам Програми та іншим повноважним представникам і сторонам використовувати вищевказані дані в цілях виконання даної Програми.


Дану згоду дано мною


__________________________________________________________________________________

(прізвище, ім'я та по-батькові кандидата повністю)


Підпис _________________________________________

(підписано добровільно і діє безстроково)


Дата____________________________________________

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