2015 Mexican Government Scholarships for International Students

MEXICAN GOVERNMENT SCHOLARSHIP PROGRAM FOR INTERNATIONAL STUDENTS

PERSONAL INFORMATIONName:

Paternal Last Name

Maternal Last Name

First Name(s)

Sex: (F)(M)

Date of Birth: / /

Day Month YearNationality:

Marital Status: Single ( ) Married ( ) Name of Spouse (husband/wife):

Address:

Street Address

City State/Province

Country

Zip CodeTelephone number (with country code):

Office Tel.:

Email*:

Passport No. ____________________________________________________________________________________________________________________________

Blood Type: _____________________________________________________________________________________________________________________________*The Foreign Ministry may contact you officially by email.Have you ever received a Mexican Government scholarship? Yes ( ) No ( )

Date and length of scholarship:

Activity or program:

________ACADEMIC PROGRAM IN MEXICOComplete name of the undergraduate, graduate or research program for which the scholarship is requested:

___________________________________

Institution:

Level of studies:

______

Program start date: / / Program end date:

/ /

Day Month Year

Day MonthYearIf you have already started the program: Start date: Current academic year:

____________

Current GPA/Other evaluations:

Period for which the scholarship is requested:

Supporting documentation must be attached.

ACADEMIC CONTACT AT THE MEXICAN INSTITUTIONName:

Institution:

Position:

Telephone:

Email:

____________

Do you have another scholarship for the same program? Yes ( ) No ( )If yes, from which institution?: Period Covered:

Type of assistance:

ACADEMIC INFORMATIONBachelors degree:

Grade Point Average (GPA):

Institution:

Start and end dates: ____________

City and country:

Masters degree:

GPA:

____________

Institution:

Start and end dates: ____________

City and country:

Doctorate:

GPA:

Institution:

Start and end dates:

City and country:

Note: A GPA of 8/10 for the most recent degree is required. If on a different scale, submit its equivalent on a 0 to 10 scale. LanguagesNative language:

__________________________________

Other languages:

EMPLOYMENT BACKGROUNDCurrent employment:

Institution or company:

Start date:

______

Position:

Previous employment:

Institution or company:

Start date: _______

Position:

TEACHING OR RESEARCH ACTIVITIESIndicate your teaching and/or research activities, with institution(s) and dates: Recent PublicationsTitles of your most recent publications related to the planned activity (5 maximum): HONORS, AWARDS AND SCHOLARSHIPSHonors and awards received:

____________

National and international scholarships for studies or research. Indicate the granting institution, country in which the activity was conducted and start and end dates:

EMERGENCY CONTACTNotify:

Relationship:

Country:

Telephone (include country and area codes):

Email:

Fax:

Address:

CONSENTI accept the terms and conditions of the 2015 Mexican Government Scholarship Program for International Students. Signature of applicant

Place and dateImportant Note: The information contained in this application will be verified by the Foreign Ministry. Giving false information will be grounds for canceling the application. -FAVOR DE LLENAR A MQUINA O COMPUTADORA. NO SE RECIBIRN MANUSCRITOS.

EN CASO DE QUE ESTE FORMULARIO SEA ALTERADO, LA POSTULACIN SER ANULADA AUTOMTICAMENTE-APPLICATION MUST BE TYPED (TYPEWRITER OR COMPUTER). HANDWRITTEN APPLICATIONS WILL NOT BE ACCEPTED. ANY ALTERATIONS TO THE APPLICATION WILL RENDER IT NULL AND VOID.