PD

PD

F-

XC

h a n g e Vi e

F-

XC

h a n g e Vi e

er

er

O W

lic

.d o

c u -tr a c k

.c

EnergyTechnologies(ENTECH) ApplicationForm
startofterm:winter2012/13

lic

MasterProgramme
w
w

bu

to

to

bu

N
.d o
c u -tr a c k

O W

.c

1. PersonalData FamilyName: Kassa

(=surnameaswritteninyourpassport)

FirstName:

Amanuel Assefa

(aswritteninyourpassport)

Gender(M=Male,F=Female):

Dateofbirth(DD/MM/YYYY):

05/02/1985

Nationality(aswritteninyourpassport):

Ethiopian ID/Passportnumber: EP0886827

Correspondenceaddress:N/Lafto k 16/17, P.O.Box 122769
, Addis Ababa , Ethiopia

Phonenumber:

+251 911 510 127 / +251 911 563 226

Email(mandatory)(whichcanbeusedtocontactyou):4amanuel@gmail.com

2. EducationalBackground
Alldegreesmentionedbelowhavetobeprovenbyofficialdocuments(Universitydegreecertificate, Universitytranscript).

Electrical Engineering Titleofthediploma:

Degreeobtainedorexpected(BSc,MSc,):BSc Dateofthediplomaobtainedorexpected:July 21 , 2007 Grade1:3.08 Nameandlocationofgrantinginstitution:Arbaminch University , Arbaminch , Ethiopia

1

Pleasenote:IfthegradingsystemdoesnotfollowtheBritish(1st,2nd,3rd),U.S.(A,B,C)orGerman

guidelines,anexplanationofthegradingsystemhastobeenclosed.

w
w

PD

PD

F-

XC

h a n g e Vi e

F-

XC

h a n g e Vi e

er

er

O W

lic

.d o

c u -tr a c k

.c

EnergyTechnologies(ENTECH)
3. Englishproficiency
Pleasenote:EnglishproficiencytestsarewaivedforapplicantswhosemothertongueisEnglishor
whohavecompletedahighereducationdegreeatuniversityinstructedinEnglishorinanEnglish speakingcountry.Theofficiallanguageofthedegreeprogrammehastobestatedinthedegree certificateoritssupplementorinthetranscriptofrecords.

lic

MasterProgramme
w
w

bu

to

to

bu

N
.d o
c u -tr a c k

O W

.c

Mothertongue: TestofEnglishasForeignLanguage(TOEFL): Kind: Result: Result: 7 Place: Place: Addis Ababa Dateofissue: Dateofissue: Dec 19,2009

IELTS: Yes

UniversityofCambridge/UniversityofOxfordCertificate
CAE: CPE:

Grade: Grade:

Place: Place:

Dateofissue: Dateofissue:

4. Documentssubmitted:
Pleasenote:Ifdocuments/certificatesarenotwritteninGerman,EnglishorFrench,youneedto
includeofficiallycertified/attestedcopiesofthecertificatesintheoriginallanguageaswellas officiallycertified/attested(copiesof)GermanorEnglishtranslationsinyourapplication.

Signedapplicationform Bachelorsdegreeorotherdegree Transcriptofrecords ProofofEnglishproficiency

5. Declaration
IherebycertifythatIhaveansweredtheabovequestionstruthfullyandcompletelytothebest ofmyknowledge.Iagreetoreportanyrelevantalterationintheinformationgivenabove.I agreethatthisapplicationandaccompanyingdocumentsshallremainwiththeKarlsruhe InstituteofTechnologyincaseIwillbeenrolledasaregisteredstudent. Date,place: 12/04/2012 Signature(writefirstnameandfamilyname):

Addis Ababa , Ethiopia

Digitally signed by Ahadu-PC\Ahadu DN: cn=Ahadu-PC\Ahadu Reason: I attest to the accuracy and integrity of this document Date: 2012.04.12 22:38:14 +03'00'

Amanuel Assefa Kassa

PleasesendyourcompleteapplicationformasPDFdocumentto: Claudia.Depenthal@kicinnoenergy.com

w
w