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*****
International course in Epidemiology, Biostatistic
s&
Qualitative research methods (EBQ)
17 October - 25 November 2016
Last Name (as indicated on your passport)
First Name
Current Nationality
Nationality at Birth
Date of Birth (in day-month-year order)
Place of Birth (as indicated on your passpor
t)
Country of Birth (as indicated on your pass
port)
Gender
Civil Status
Minors (name and age)
Current Residence Address
Phone Number(s)
E-mail
o
o
o
Specify level of education
Bachelor
Master
Enrolled PhD student:
o University:
.
o PhD promoter(s):
..
To apply for the EBQ Course 2016 kindly fill in this form, preferably digitally, or write legible (block l
etters). Kindly submit 1)
this application form, 2) a recent CV (max. 2 pages) and 3) a letter of support from your su
pervisor to
global.health.institute@uantwerp.be.
Starting the 2016 edition VLIR-UOS scholarships are available. To see whether you are eligible to
apply, kindly go to page 6.
Submission deadline is 1 May 2016.
Passport Number
Issue Date
Issued by (the authority that issued the pa
ssport
and
the place
of issue)
Expiration
Date
Name of the organisation (pu
blic EBQ 2016 Application Form
service,
educational
1/6
instituti
on)
2. Current jo
b
Employers address
Supervisors name
1.Short
Personal
detai
description
(200 words):
ls
2/6
5. Prior knowledge (Tick as appropriate; you are allowed to tick several options)
6. Software knowledge (Tick as appropriate; you are allowed to tick several options)
SPSS
R
STATA
SAS
ATLAS
NVIVO
Other: .
7. Data set
8. Personal motivation
Describe why it is important for you to attend this course.
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Signature of applicant
Kindly submit 1) this application form, 2) a recent CV (max. 2 pages) and 3) a letter of support fro
m your supervisor to
global.health.institute@uantwerp.be. Submission deadline is 1 May 2016..
5/6
o
o
o
self-sufficient
supported by a VLIR-UOS project (TEAM or IUC):
receiving a support grant from
VLIR-UOS scholarships
Please read carefully the eligibility criteria below to check whether you qualify for a VLIR-UOS Scholarship
application. Only if you
can tick all the boxes, you may continue to complete the form. If you have any questions related to these ei
ght criteria, kindly
contact global.health.institute@uantwerp.be.
I currently live in and have the nationality of one of the 54 countries from the country list (see below
). Note: You do not
need to have the same nationality and place of residence. However, applicants need to be a residen
t in one of those
countries at the time of application.
On 01 January 2016 I am not older than 45 years of age.
I am employed by an academic institution, research institute, public service, social economy or NGO.
This is the only VLIR-UOS scholarship I am applying for this year (2016).
I have never before received a VLIR-UOS scholarship to attend an International Training Programme
(like EBQ)
I am not in any way involved in a VLIR-UOS sponsored IUS or TEAM project, nor another DGD sponsor
ed project.
**************
54 VLIR-UOS scholarship countries
Africa: Benin, Burkina Faso, Burundi, DR Congo, Ethiopia, Gambia, Ghana, Guinea, Ivory Coast, Cameroon,
Kenya,
Madagascar, Malawi, Mali, Morocco, Mozambique, Nigeria, Rwanda, Senegal, Tanzania, Togo, Tunisia, Ugan
da, Zambia,
Zimbabwe, South Africa
Asia: Bangladesh, Cambodia, Philippines, India, Indonesia, Jordan, Laos, Nepal, Palestinian Territories, Sri L
anka, Thailand,
Vietnam
Latin America: Bolivia, Brazil, Colombia, Cuba, Dominican Republic, Ecuador, Guatemala, Guyana, Hondu
ras, Haiti, Mexico,
Nicaragua, Paraguay, Peru, Suriname, Uruguay
**************
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