Armenian British Connect

GENERAL INFORMATION:

First Name*

Middle Name

Family Name*

Full Name in Native Language*

Sex*

Male

Female

Marital Status*

Single

Married

Academic Title (if any)

Date of Birth*

Place of Birth*

Citizenship*

CONTACT INFORMATION:

Address (permanent)*

Mailing Address (if different from above)

Email address*

Mobile Number*

Home Telephone

OfficeTelephone

LANGUAGE SKILLS:

Language - 1*

Level (scale 1 - 5)*

Language - 2*

Level (scale 1 - 5)*

Language - 3

Level (scale 1- 5)

Language - 4

Level (scale 1- 5)

List any other languages spoken

SECONDARY EDUCATION:

Name/Number of the Last School Attended*

City/Village*

Country*

From -To (please indicate period attended)*

HIGHER EDUCATION:

Name of the University*

Department*

City*

Country*

From-To (dates attended)*

Degrees Recieved*

Field of Study*

Other academic institutions (please fill this box in the same format as above)

PRACTICAL OR PROFESSIONAL WORK DURING AND AFTER HIGHER EDUCATION:

From-To*

Organization Name*

Organization Address*

Industry*

Field of Your Expertise*

Position/Professional Status (give exact title)*

Other work experience (please fill this box in the same format as above)

APPLICANT QUESTIONNAIRE:

Previous visits abroad for study or work of at least one month (From.../to... Where? What? Financed by?)*

Please list the fields of your academic interests*

Please list your memberships, if any, to any organizations that have a political agenda*

Please asses the level of your motivation towards academic growth on the scale of 1 to 10*

Please list the fields of your professional interests*

Please asses the level of your motivation towards professional growth on the scale of 1 to 10*

Please list the fields of your social interests*

Please asses the level of your motivation towards social activity on the scale of 1 to 10*

Would you like your basic info to appear in the Membership section of our web-site? (yes/no)*

* - the completion of these fields are compulsory

*The information provided will not be made public, but after the admission your email will be included in the ABC mailing list.

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