APPLICATION FORM FOR SCHOLARSHIPS IN ROMANIA AND FOR THE ISSUANCE OF LETTER OF ACCEPTANCE TO STUDIES

Nr. Ref……………..

MINISTERUL AFACERILOR EXTERNE /MINISTERUL EDUCATIEI Ş I CERCETĂ RII

MINISTRY OF FOREIGN AFFAIRS / MINISTRY OF EDUCATION AND RESEARCH

MINISTERE DES AFFAIRES ETRANGERES / MINISTERE DE L’EDUCATION ET DE LA RECHERCHE

APPLICATION FORM FOR SCHOLARSHIPS IN ROMANIA AND FOR THE ISSUANCE OF LETTER OF ACCEPTANCE TO STUDIES

DEMANDE DE BOURSE D’ETUDES EN ROUMANIE ET D’APPLICATION POUR LA LETTRE D’ACCEPTATION AUX É TUDES

(to be filled in with capital letters / à complé ter en majuscules)

1. SURNAME / NOMS_______________________________GIVEN NAMES / PRENOMS_______________________________________________________

2. PREVIOUS SURNAMES / NOMS PORTE ANTERIEUREMENT __________________________________________________________________________

3. DATE AND PLACE OF BIRTH / DATE ET LIEU DE NAISSANCE

COUNTRY / PAYS _________________________________PLACE / LOCALITE _______________________ DATE / DATE __________________________

D D M M Y Y Y Y

4. PARENTS GIVEN NAMES / PRENOMS DES PARENTS ________________________________________________________________________________

5. SEX / SEXE: M F

6. CIVIL STATUS / ETAT CIVIL: MARRIED / MARIE(E) SINGLE / CELIBATAIRE DIVORCED / DIVORCE(E) WIDOWER / VEUF

7. ACTUAL CITIZENSHIP(S) / NATIONALITE(S) ACTUELE(S) ___________________________________________________________________________

PREVIOUS CITIZENSHIPS / NATIONALITES ANTERIEURES ____________________________________________________________________________

8. TRAVEL DOCUMENT / DOCUMENT DE VOYAGE: TYPE / TYPE ________________________________SERIES_______________________________

NO. __________________________________________ COUNTRY ISSUED BY / EMIS PAR PAYS _______________________________________________

DATE OF ISSUE / DATE DE DÉ LIVRANCE__________________________________VALADITY / EXPIRANT LE _________________________________

(DATE OF ISSUE/A) D D M M Y Y Y Y D D M M Y Y Y Y

9. ACTUAL PERMANENT RESIDENCE / COUNTRY / PAYS ______________________________CITY / VILLE ___________________________________

10. PROFESSION / PROFESSION _________________________________________ WORK PLACE / LIEU DE TRAVAIL ____________________________

11. The complete mailing address / L’adresse postale complè te: _________________________________________________________________

__________________________________________________________________________________________________________________________________

12. The e-mail address / L’adresse de courriel é lectronique: ______________________________________________

I. Academic Qualification / Instruction scolaire

Name and Location of the Secondary School / University Nom et adresse du Lycé e / Université	Date of Admission / Date of Completion Date d’Admission / Date de Finalisation	Type of Diploma obtained Type de diplô me reç u