Author: Daniel Müller-Gritschneder
Company: TU München

APPLICATION for MB-JASS 2012
I apply for admission to course with topic

Automation and Methods  for Nanoscale IC Design

for MB-JASS 2012 in Herrsching, Germany, organized by the Technische Universität München and the Moscow State Institute of Electronic Technology (Technical University) from March 27th through April 2nd, 2012.

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Place, date signature

A) Personal information (please print)
Mrs. Mr.
Name: ........................................................................................................................................ 
Prename/s: .................................................................................................................................
Date of birth: ........................................................................…...................................................
Place of birth: .............................................................................................................................
Current university: .............................................…..................................................................... 
Nationality: ..................................................................................................................….........…
email-address: .....................................................................................................…………….....
address of study*): ..................................................................................................……......................................
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Phone: ....................................................................
Home address*): ...............................................................................................................................................
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Phone: ....................................................................
*please check the address to be used for letters
B) Educational data
Certificate for admission to university (please attach copy of certificate): ...........................……………..
Average grade: ........................................................................................................................................
Place, school: .................................................................................. Year: ............................……………
C) Studies
Begin of studies: ...........................................................…………..... Field: ...........................................
University: ..............................................................................................................................................
Current field: .......................................................................................……………..Semester: ................. 
Current university: ....................................................................................................................................
D) Qualifications
Certificate of Bachelor, DVP or similar with date of: ...................................................…………………... (attach copy)
Field: ..................................................................................................................... 
Average grade: ………………………………………………………............................
University:.............................................................................................................…
Please also attach copies of further qualifications (seminars, courses, labs, etc.)
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Explain briefly your special interest in participation in this course:

Please add the following attachments to your application:
•	Curriculum vitae
•	Certificate for admission to university 
•	Certificate of Bachelor, DVP or similar

Any further certificates of relevance:
•	.......................................................................................................................................
•	.......................................................................................................................................
Please send your application to the local course teacher of the selected course.
Deadline for delivery of applications: February 12, 2012