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Application Form

PLOCAN Summer School - Application Form

    *Required fields

    1. Title

    2. Name*

    3. Surname*

    4. Please Input your Gender*

    5. Please State your Nationality*

    6. Year of Birth*

    7. Address Line 1*

    8. Address Line 2

    9. City*

    10. State/Region/County*

    11. Postal/Zip Code*

    12. E-mail*

    13. Mobile Phone Number*

    14. Higher Education or Research Institute*

    15. Please Indicate level of Educational Attainment *

    15a. If you selected other, please specify:

    16. Where did you hear about this program? *

    16a. If you selected other, please specify:

    Professional - University or technical (professional training) degree related to marine/maritime sectors and/or marine technology

    18. Position*

    19. Institution*

    20. Country*

    21. Address 1*

    21. Address 2

    22. City*

    22. Postal Code*

    Training Information

    23. Please outline your expertise in marine/maritime and/or engineering fields (500 characters MAX)*

    24. Please outline your expertise in marine technology with focus on ocean robotics (500 characters MAX)*

    25. Please attach CV here as a PDF document (2 pages MAX) using this naming format: JaneDoe_CV.pdf*

    26. Please attach a motivation letter here as a PDF document (2 pages MAX) using this naming format: JaneDoe_motivation.pdf*

    Certificates (not mandatory)

    27. Do you have a Seafarers Medical Certicate

    27a. Certificate Name (eg ENG II)

    27b. Date Certificate Issued

    28. Do you have a Seafarers Personal Survival Training (PST) certificate

    28a. Certificate Name (eg STCW 95)

    28b. Date Certificate Issued

    Application Check List

    HAVE YOU Completed every part of the application form?

    Personal and Academic details

    Personal Statement

    Attached a copy of your most recent Curriculum Vitae

    Certificates