APPLICATION FORM 2019 MEXICAN GOVERNMENT ... - gob.mx · ACADEMIC INFORMATION RESPONSIBLE AUTHORITY WITH WHICH YOU HAVE CONTACT TO CONDUCT ACTIVITIES IN MEXICO Plaza Juárez Núm

Plaza Juárez Núm. 20, Piso 4, Col. Centro, Del. Cuauhtémoc, C.P. 06010, Ciudad de México.t. (55) 3686 - 5100 | www.gob.mx/amexcid

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INFORMATION ABOUT THE APPLICANT

A P P L I C A T I O N F O R M

2019 MEXICAN GOVERNMENT SCHOLARSHIP PROGRAM FOR INTERNATIONAL STUDENTS

f m

fill out this form on a computer. no handwritten text will be received

street address / interior number / exterior apt number

city / town

indicate international dialing code


state / province zip code

In case this form is altered the application will be canceled automatically

Current photo (no more than 30 days) with the following speci�cations: white background, frontal view, no glasses, head and face exposed, without smiling.

Upload on .pdf format

(if applicable)

dd/mm/yyyy


last name(s):

name (s):

nationality:

current address:

home phone number:

cellphone number:

gender:

email address:

passport number: blood type:

country of origin: current country of residence:

civil status:

spouse or partner’s name

date of birth:

office phone number:

ACADEMIC ACTIVITY TO BE CONDUCTED IN MEXICO


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yes no

yes no

yes no

Mexican Government Scholarships for International Studentscall 2019

it is required to enclose supporting documents for the application

dd/mm/yyyy dd/mm/yyyy(of the academic program)

dd/mm/yyyy dd/mm/yyyy

(of the academic program)


receiving mexican institution:

start date:

academic cycle you are currently studying:

grade point average:

specific period for the scholarship application (start and end dates):

have you already started the studies:

are the studies you intend to carry out in mexico taught in your country of origin?

end date:

activities conducted during the scholarship:

start date: end date:

academic modality to be conducted:

have you obtained a scholarship from the mexican government?


ACADEMIC INFORMATION

RESPONSIBLE AUTHORITY WITH WHICH YOU HAVE CONTACT TO CONDUCT ACTIVITIES IN MEXICO


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yes no


the grade point average must be inputed in the mexican scale: 0/100

In case of being on a different scale, it is required to present its equivalence.

indicate start and end dates


full name of the responsible:

receiving institution:

email address:

from which institution?

phone number: position:

do you have any support to conduct the activity for which you are applying for this scholarship?

academic period:

type of support:

undergraduate studies

academic program:

city and country:

institution:



EMPLOYMENT INFORMATION


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entry date:


dd/mm/yyyy

dd/mm/yyyy



dd/mm/yyyy

institution or company:

current work activity:

job position:

institution or company:

previous employment:

master’s degree studies:

academic program:

city and country:

institution:

doctoral studies:

end date



academic program:

city and country:

institution:



entry date:

job position:


TEACHING AND RESEARCH ACTIVITIES

RECENT PUBLICATIONS

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DISTINCTIONS, AWARDS AND SCHOLARSHIPS


(a maximum of 5)

(if applicable)


institution:

teaching and research activities conducted:

starting date: termination date:

name your most recent publications regarding the academic studies to be conducted:

name the distinctions, awards and scholarships obtained indicating dates:


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IN CASE OF EMERGENCY

important note: the information contained in this application will be verified by amexcid. in case it is found to be false the request shall be cancelled






granting institution:

name of the person to notify:

relationship:

applicant’s signaturedate and place

country:

cellphone number:phone number:

address:

granting institution:

in case of having obtained national or international scholarships to conduct studies or research. name the most recent:

country in which you conducted your studies/research:

i hereby acknowledge that i have read, understood and accept the terms and conditions of the 2019 mexican government scholarships for international students call



country in which you conducted your studies/research:

Documents

APPLICATION FORM 2019 MEXICAN GOVERNMENT ... - gob.mx · ACADEMIC INFORMATION RESPONSIBLE AUTHORITY WITH WHICH YOU HAVE CONTACT TO CONDUCT ACTIVITIES IN MEXICO Plaza Juárez Núm