B: Applicant s Information B-1: Personal Information (i) Title Mr Mrs Miss M Others (ii) Marital Status

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1 For Official Use Only Ref. No Code THE NELSON MANDELA AFRICAN INSTITUTION OF SCIENCE AND TECHNOLOGY (NM-AIST) ARUSHA Affix a color Photograph (35mm x 45 mm) APPLICATION FORM FOR ADMISSION INTO POSTGRADUATE STUDIES AT NM-AIST FOR 05/6 ACADEMIC YEAR A: General Instructions Read carefully the application information and instructions before filling this form. Applicant s information written and submitted herein MUST be correct, complete, genuine and reliable. Write your information by ticking ( ) in the appropriate boxes or by filling empty spaces. Choose the degree programme you are interested to study basing on your priorities i.e. ranked from the first priority as, the second priority as and third priority as 3 for a maximum of 3 choices. Presentation of wrong information and/or forged academic certificates and transcripts and other information shall lead to disqualification from admission and legal actions may be taken against the wrongdoer. Application package MUST be accompanied by the most up to date CV. (vii) Names and other academic information should appear as they appear in your certificates and/or transcripts. (viii) Payment of application fees is a prerequisite for processing your application. B: Applicant s Information B-: Personal Information Title Mr Mrs Miss M Others Marital Status Single Married Names Surname Middle/Other Names Date of birth / / Date / Month / Year Nationality First Name

2 B-: Contact Information Country Street address Town/City Postal code/address C: Application Information C-: The Intended Degree Programme (Please tick appropriate box) Masters PhD C-: The Mode of Study (Please tick appropriate box) Coursework Thesis C-3: The Degree Programmes and Areas of Specialization to Which Admission is Sought (please choose basing on your priorities) School of Life Sciences and Bioengineering (LiSBE) S/N Cluster Degree Programme Areas of Specialization Choices Life Sciences and (LiSE) Bio-engineering Master s in Life Sciences and PhD in Life Sciences and Master s in Bioengineering PhD in Bioengineering Health and Biomedical Sciences Sustainable Agriculture Food and Nutritional Sciences Biodiversity and Ecosystems Management Bioproduct Development Vaccines and Diagnostics Development School of Communication and Computational Science and (CoCSE) S/N Cluster Degree Programme Areas of Specialization Choices Master s in Mathematical and Applied Mathematics and Mathematical and Computer Science and Computational Science Computer Science and PhD in Mathematical and Computer (MCSE) Computer Science and Science and Information and Communication Science and (ICSE) Master s in Information and Communication Science and PhD in Information and Communication Science and Information Technology Systems Development and Management Electronics and Telecommunications

3 School of Materials, Energy, Water and Environmental Sciences (MEWES) S/N Cluster Degree Programme 3 4 Materials Science and (MaSE) Sustainable Energy Science and (SESE) Hydrology and Water Resources (HWRE) Environmental Science and (EnSE) Master s in Materials Science and PhD in Materials Science and Master s in Sustainable Energy Science and PhD in Sustainable Energy Science and Master s in Hydrology and Water Resources PhD in Hydrology and Water Resources Master s in Environmental Science and PhD in Environmental Science and Areas of Specialization Structural Materials Energy Materials Sustainable Power Generation and Energy Utilization Sustainable Renewable Energy Sustainable Nuclear Power Hydrology and Climate Studies Water Resources Irrigation Water Supply and Sanitation Environmental Science Environmental Choices C-4: Sponsorship How do you intend to finance your studies? Self Employer Family Solicit a scholarship Others, please specify C-5: Name and Contact Addresses of Sponsor (if available) Full Name Address 3

4 C-6: Certification of Employment and Grant of Study Leave Are you employed? Yes No If employed, please specify the organization you are working in, position/title and contact address of employer Organization Position/Title Postal address address D: Academic, Professional and Career Information D-: Academic Background Information (Fill in the chorological order) S/N Period School/ College/ Location/ Level of Education Title of the Course/Degree (From YY to YY) University Country Attained Completed/Awarded D-: Academic Awards (GPA/Grade/Division)(must match your certificates and transcripts) S/N Course/Degree Attended GPA/Grade/Division Certificate of Secondary Education Examination (CSEE) Advanced Certificate of Secondary Education Examination (ACSEE) Certificate (if any) Ordinary Diploma (if any) Advanced Diploma Bachelor Degree (vii) Postgraduate Diploma (If any) (viii) Master s Degree (Applicable for PhD applicants) D-3: Experience in Professional Works (in chronological order) S/N Period (From YY to YY) Institution/Company Position Held Summary of Duties Performed 4

5 D-4: Experience in Research Work (in chronological order) S/N Period (From YY to YY) Title of Research Project/Programme (vii) (viii) D-5 Key Achievements List Publications, Theses, Books, Innovations, Systems Designed/Developed and Prizes (if any) (vii) (viii) Research Board to Which Research Work was Presented/Accepted D-6 Additional Requirements for Students Applying for Master s and PhD by Research and Thesis D-6. Masters by Thesis Submit along with the application documents, a concise ONE-page concept note of what you wish to research on as part of the study in order to demonstrate your ability to organize thoughts in writing, logically and creatively. D-6. PhD by Thesis Submit along with the application documents, a concise TWO-page concept note of what you wish to research on as part of study in order to demonstrate your ability to organize thoughts in writing, logically and creatively. D-7 Referees Names of TWO persons whom you have requested to be your referee (Your referees must fill forms NM-A0) Full name: Position/Title: Institution: Address: Full name: Position/Title: Institution: address: 5