Applicant’s name, surname, title: ……………………………………………………………………………………………………………..
Date (DD,MM,YYYY) and place of birth: …………………………………………………………………………………………………….
Passport number: ………………………………………… Nationality:………………………………… Male/Female: …………..
Permanent residence address (Street, City, Zip code, Country): …………………………………………………………………….
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Address for correspondence (if other than above): ………………………………………………………………………………………
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E-Mail: ……………………………………………………………………………… Mobil/Phone: . …………………………………………………
Academic History (University, College, Study programme, Diploma Thesis Title, Date, Degree): ………………………………………………………………………………………………………………………………………………………………………..
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Employer (Address, job): …………………………………………………………………………………………………………………………………
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I apply for  full-time  –  part-time  Doctoral Study in the Study Branch: 
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Department: …………………………………………………………………………………………………………………………………………………
Supervisor: ……………………………………………………………………………………………………………………………………………………
Ph.D. Thesis Topic: ……………………………………………………………………………………………………………………………………….
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Knowledge of Languages / degree (English, German. French, Russian, Spanish, Czech): ………………………………….
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Results obtained during the higher education, graduates of the Czech Technical University may leave this part empty and submit the transcript of records from KOS, average grades from years:

1st:		2nd:		3rd:		4th:		5th:		6th:

Principal Courses in the last 2-3 Years of the Study:
Title of a Course									Result

		

		

		

		

Declaration:
I hereby apply for admission to doctoral study at the Czech Technical University in Prague, Faculty of Electrical Engineering. I agree with the collection and processing of the personal data given above by the university, in accordance with the Act. No. 101/2000 Coll., on personal data protection. I acknowledge that the data given in this application form will be used for the purposes of processing this application and for other administrative purposes related to my doctoral study.
I confirm that the information provided above is correct to the best of my knowledge.

Date: ……………………………………………  Signature of Applicant: …………………………………………………….. ………….

The applicant shall submit the following documents with this application form:
a)	Confirmation of payment fee of the admission procedure.
b)	Curriculum vitae.
c)	Copies of your certificates and transcripts (recognition of the previous level of education achieved in another country than the Czech Republic or the Slovak Republic is subject to the law – contact Rector’s Office of the CTU, Department of Education).
d)	List of published and unpublished articles, papers, etc.