Fauzi Putra - Wilhelminenstr.

10 - 95444 Bayreuth - Germany

Universitt Bremen
-SFSI-
Online-Bewerbung
Bibliothekstr. 1
28359 Bremen
Germany

Universitt Bremen Application Form

for the winter semester 2017/18

Family name Putra

First name Fauzi
Application No. 5075478
Degree course Epidemiologie (Master of Science)
Gew. Fachsemester 1
Birthdate 24th Dec. 1990

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UNIVERSITT BREMEN APPLICATION FORM FOR THE WINTER SEMESTER 2017/18
5075478 - Putra, Fauzi

Personal details

Family name Putra

Name affix Dharma
First name Fauzi
M/F male
Date of birth 24th Dec. 1990
Country of birth Germany
Place of birth Surabaya
Nationality (country) Indonesia

Current postal address

Street and street number Wilhelminenstr.10

Supplement (e. g. c/o)

Postal/Zip code 95444

City Bayreuth
Country Germany
Phone No.

E-mail address fauzi.putra@web.de

Mobile No +4915207950080

Permanent address (If is not the correspondence address)

c/o

Street and street number

Supplement (e. g. c/o)

Postal/Zip code

City

Country

Selected Degree Course

Degree Course Epidemiologie (Master of Science)

Degree Master of Science
Semester of application winter semester 2017/18
Wanted Semester 1
Form of study Postgraduate studies

General Information

State of acquisition of eligibility for university Indonesia

entrance

Date of graduation of the first admission 14th Jun. 2008

qualification

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UNIVERSITT BREMEN APPLICATION FORM FOR THE WINTER SEMESTER 2017/18
5075478 - Putra, Fauzi

Eligibility for university entrance

Name of the certificate in the original language Ijasah Sekolah Menengah Atas
Begin of school education Jun. 2005
End of school education Jun. 2008
Grade point average 1,6
Did you pass an additional university entrance Yes
exam?

If yes, which one? PMDK II

If yes, please state date of university entrance 13th Aug. 2008
exam

Master admission qualification

Date of graduation 7th Jul. 2012

Country of graduation Indonesia
Grade point average 1,6

Earlier studies

Place of university in Germany Fulda

Name of University Fachhochschule Fulda
Semester of first enrolment winter semester 2017/18
Do you have failed an intermediate or final No
examination at a German University/College
in a program equivalent to the one you are
applying for?

Number of semesters

Numbers of semesters studied at German 0

universities or universities in the EU

of which leave-of-absence semesters 0

Last degree

Have you earned a degree from a university/ Yes

college?

Country of university Indonesia

Form of study First degree
1. Subject Gesundheitswissenschaft/-management
2. Subject

3. Subject

Date / Estimated date of graduation 7th Jul. 2012

Status of examination Passed
Grade point average 1,6

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UNIVERSITT BREMEN APPLICATION FORM FOR THE WINTER SEMESTER 2017/18
5075478 - Putra, Fauzi

Language Skills

Language German
Language test Level B2
Grade / Rating 216
Institution Inlingua Nrnberg
Date of examination or expected date of Oct. 2016
examination

Language English
Language test TOEFL PBT
Grade / Rating 573
Institution Airlangga University
Date of examination or expected date of Nov. 2015
examination

Further information

How did you find out about your chosen Home university
degree course?

Are you currently enrolled at University of No

Bremen?

Certificates and other documents

Bachelor's or diploma's certificate Bachelor Certifi.pdf

Transcript of records Academic Transcr.pdf
Letter of motivation Motivationsbrief.pdf
Curriculum vitae Lebenslauf neue.pdf

Language certificates

German language Certificate TELC_B2_Zertifik.pdf

English language Certificate toefl itp-ilovep.pdf

Other

Further interships, ... certificate proof of interns.pdf

Additional documents Recommendation L.pdf
Additional documents teilnahme iik.pdf

Legal Notice
Affirmation 1. I affirm that I have not concealed active or further studies. 2. I affirm that all of my given information are true and
complete. 3. I know that the enrolment will be returned if I have done untrue information. 4. I notice that Bremen University/College
act does not allow to be enrolled at Bremen University if I enrolled in another university or college. If I sent the data I accept the
aforesaid facts.

Date Signature

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