APPLICATION FORM

(This application form is free of charge and may be duplicated.)

Deadline for receipt of this application is June 25, 2012.

Early applications are encouraged.
Surname, name:

_________________________________________________________________________
(as indicated in foreign passport)

Surname, name, patronymic: ________________________________________________________________________

(as indicated in Ukrainian passport)
Citizenship:

__________________________________________________________________________

Date of Birth:

__________________ Place of Birth: ___________________________________________

Current Address:

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

Permanent Address:
(if different from above
address)

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

Telephone Numbers:
home____________________ work_____________________________________________
(area code to be indicated)
mobile _______________________
Fax:

__________________________________________________________________________

E-mail:

__________________________________________________________________________

Alternate telephone
number where message
may be left for applicant
(e.g., phone number of
relative, neighbor, etc.):

__________________________________________________________________________

If you are admitted to the 1). Deferred Tuition:

2). Deferred Housing Support No ___ Yes ___
KSE, will you apply for:
a). In case you wouldnt get a full scholarship
No ___ Yes ___
b). In case you wouldnt get a partial scholarship No ___ Yes ___
Note the source which
KSE Website or other Internet source
Mass Media _________________________
influenced your decision to
(please specify the sources web address)
____________________________________________________
apply to the School
KSE student/ graduate
KSE Partners (AIESEC, ACCELS,
CEP, IREX, IRF/ Osvita, CEUME) ____________________________
Educational exhibition (please specify) ________________________

Student Organization (please specify) __________________

KSE Open House

University (department, name of person) __________________________________________________________

Presentation by KSE staff or faculty

Other (please specify)

_____________________________________________

1. List universities and institutes attended, years of attendance, degree conferred or expected, and specialization
(begin with most recent educational institution):
Institution attended

Years

Degree

Specialization

(e.g. 2003-2007) (BA/Specialist/Other)

2. List economics courses taken (additional page can be attached):

Course

Year of study

Grade

Year of study

Grade

Institution

3. List mathematics and statistics courses taken:

Course

Institution

4. Other relevant studies and dates (short-term courses, certificate courses, study abroad, trainings, etc.):
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
5. Academic honors and dates received (e.g., Red Diploma, 1990) _________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
6. Research in progress, publications ________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
7. Professional experience:
Employer

Job Title

Dates

Part-time / Full-time

8. Describe your study of Englishwhere you studied, number of years, special courses attended, etc.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
9. If you have taken the TOEFL exam, please indicate your score ________ and the date taken
____________________. Please attach a photocopy of your score report.
10. Please indicate your proficiency in English on the following scale:
Poor

Good

Excellent

Ability to read a newspaper, magazine, textbook

Listening comprehension in conversation, lectures
Writing and composition

11. STATEMENT OF PURPOSE

(On an additional sheet of paper, please write a 250-word essay on why you wish to study economics and how a
masters degree in economics is related to your career goals and intellectual interests).