Research MSc Application – Quantum Leap Africa

Program to Apply For*
Name
First Last
Other Names Preferred Name (User ID/E-Mail etc)
DOB/Gender/Marital Status - First Row
Date of Birth
Date Format: MM slash DD slash YYYY
DOB - Column End
Gender - Column Start
Gender
Gender - Col END
Marital Status - Col Start
Marital Status*
- Single
- Married
- Divorced
Marital Status - Col End
Country - Col Start
Country of Citizenship*
Other Country
Country - Col END
CONTACT INFORMATION - New Row
Contact
CONTACT INFORMATION
Email
Email -Column END
Phone - Col START
Phone
Phone - Col END
ADDRESS - New Row
Home Address - Col START
Home Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Address -Col END
Mailing Address - Col Start
Mailing Address (If Different From Home Address)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mailing Address -Col EBND
POST SECONDARY INFORMATION - New Row
Post-Secondary Information
PREVIOUS INSTITUTIONS
Number of Previous Institutions
# Previous Institutions - Col END
Previous Institutions - New Row
INSTITUTE 1
Name of Institution 1*
Country of Institution 1*
Date of Entry*
Date Format: MM slash DD slash YYYY
Date of Completion/Expected Graduation*
Date Format: MM slash DD slash YYYY
Area of Study (1)*
Advisors (if applicable)
Thesis Topic
Degree Awarded
institute1 end
INSTITUTE 2
Name of Institution 2*
Country of Institution 2*
Date of Entry*
Date Format: MM slash DD slash YYYY
Date of Completion/Expected Graduation*
Date Format: MM slash DD slash YYYY
Area of Study (2)*
Advisors (if applicable)
Thesis Topic
Degree Awarded
institute2 end
INSTITUTE 3
Name of Institution 3*
Country of Institution 3*
Date of Entry*
Date Format: MM slash DD slash YYYY
Date of Completion/Expected Graduation*
Date Format: MM slash DD slash YYYY
Area of Study (3)*
Advisors (if applicable)
Thesis Topic
Degree Awarded
institute3 end
RESEARCH INTERESTS
Research Interests
RESEARCH INTERESTS
Research Interests
Research Interests - Col END
Other Interests - Col Start
Other Research Interest:
Other Interests - Col END
SUPPORTING DOCUMENTS - New Row
SUPPORTING DOCUMENTS UPLOADED
Files to Upload (This may include CV, statement of purpose, and transcripts
Files To Upload:
Drop files here or
PUBLICATIONS
Publications
Number of Publications
PUBLICATION 1
Title
Journal
Co-Authors
Publication Date (Or Date Submitted)
Date Format: MM slash DD slash YYYY
publication end 1
PUBLICATION 2
Title
Journal
Co-Authors
Publication Date (Or Date Submitted)
Date Format: MM slash DD slash YYYY
publication end 2
PUBLICATION 3
Title
Journal
Co-Authors
Publication Date (Or Date Submitted)
Date Format: MM slash DD slash YYYY
publication end 3
REFERENCES - New Row
References
Please provide the information requested below for two referees. Your referees will receive an email with your name and a request with a link to upload their recommendation letter to your application.
Please note that all letters of reference must be on institution letterhead and must be signed by the referee.
Instructions for submitting Letters of Reference via the online application:
Referees that you enter in your application will receive an email containing a link that will take them to a secure, confidential web interface at QLA. Referees can use this web interface to submit their letter of reference directly into your application file at QLA.
All letters of reference must be received no later than the application deadline.
Reference #1
REFERENCE 1
First Name
Last Name
Position
E-mail (Referee 1)
University/Organization
REFERENCE 1 END
new row
Reference #2
REFERENCE 2
First Name
Last Name
Position
E-mail (Referee 2)
University/Organization
REFERENCE 2 END
OTHER INFORMATION - New Row
Other Information
Other Information
Skills & Interests
Skills - Col END
Scholarships - Col Start
Scholarships/Prizes/Awards
Scholarships - Col END
Other Information - Row 2
Disability Info
Learning/Physical/Accessibility/Mobility Needs
Disability Info - Col END
Career Goals
Career Goals
Career Goals - Col END
new row
EMERGENCY CONTACTS
Emergency Contact
Street Address Address Line 2 City E-Mail Country
EMERGENCY CONTACT END
EMERGENCY PHONE
Emergency Phone Contact
EMERGENCY PHONE - COL END

DOB/Gender/Marital Status - First Row

DOB - Column End

Gender - Column Start

Gender - Col END

Marital Status - Col Start

Marital Status - Col End

Country - Col Start

Country - Col END

CONTACT INFORMATION - New Row

CONTACT INFORMATION

Email -Column END

Phone - Col START

Phone - Col END

ADDRESS - New Row

Home Address - Col START

Home Address -Col END

Mailing Address - Col Start

Mailing Address -Col EBND

POST SECONDARY INFORMATION - New Row

PREVIOUS INSTITUTIONS

# Previous Institutions - Col END

Previous Institutions - New Row

INSTITUTE 1

institute1 end

INSTITUTE 2

institute2 end

INSTITUTE 3

institute3 end

RESEARCH INTERESTS

RESEARCH INTERESTS

Research Interests - Col END

Other Interests - Col Start

Other Interests - Col END

SUPPORTING DOCUMENTS - New Row

SUPPORTING DOCUMENTS UPLOADED

PUBLICATIONS

PUBLICATION 1

publication end 1

PUBLICATION 2

publication end 2

PUBLICATION 3

publication end 3

REFERENCES - New Row

Instructions for submitting Letters of Reference via the online application:

All letters of reference must be received no later than the application deadline.

Reference #1

REFERENCE 1

REFERENCE 1 END

new row

Reference #2

REFERENCE 2

REFERENCE 2 END

OTHER INFORMATION - New Row

Other Information

Skills - Col END

Scholarships - Col Start

Scholarships - Col END

Other Information - Row 2

Disability Info

Disability Info - Col END

Career Goals

Career Goals - Col END

new row

EMERGENCY CONTACTS

EMERGENCY CONTACT END

EMERGENCY PHONE

EMERGENCY PHONE - COL END