Research MSc Application – Quantum Leap Africa

Program to Apply For*
Name
First Last
Other Names Preferred Name (User ID/E-Mail etc)
- Date of Birth
  Date Format: MM slash DD slash YYYY
- Gender
- Marital Status*
  - Single
  - Married
  - Divorced
- Country of Citizenship*
- Other Country
Contact
- Email
- Phone
- Home Address
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- Mailing Address (If Different From Home Address)
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Post-Secondary Information
- Number of Previous Institutions
- 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
- 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
- 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
Research Interests
- Research Interests
- Other Research Interest:
- Files to Upload (This may include CV, statement of purpose, and transcripts
- Files To Upload:
  Drop files here or
- Publications
- Number of Publications
- - Title
  - Journal
  - Co-Authors
  - Publication Date (Or Date Submitted)
    Date Format: MM slash DD slash YYYY
- - Title
  - Journal
  - Co-Authors
  - Publication Date (Or Date Submitted)
    Date Format: MM slash DD slash YYYY
- - Title
  - Journal
  - Co-Authors
  - Publication Date (Or Date Submitted)
    Date Format: MM slash DD slash YYYY
- 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
- - First Name
  - Last Name
  - Position
  - E-mail (Referee 1)
  - University/Organization
- Reference #2
- - First Name
  - Last Name
  - Position
  - E-mail (Referee 2)
  - University/Organization
- Other Information
- - Skills & Interests
- - Scholarships/Prizes/Awards
- - Learning/Physical/Accessibility/Mobility Needs
- - Career Goals
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- - Emergency Contact
    Street Address Address Line 2 City E-Mail Country
- - Emergency Phone Contact
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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 #2

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