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Application Identification No./ Número de identificación de la solicitud/ Identifikační číslo žádosti:

2015/16_BD_31BBA

Knowledge test/ El test de conocimiento/ Test znalostí English test/ El test de Inglés/ Anglický test

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APPLICATION FOR THE CZECH GOVERNMENT SCHOLARSHIP SOLICITUD DE LA BECA DEL GOBIERNO DE LA REPÚBLICA CHECA FORMULÁŘ ŽÁDOSTI O STIPENDIUM VLÁDY ČR Academic year/ Año académico/ Akademický rok: 2015/2016
1. Nationality/ Nacionalidad/ Státní příslušnost Bangladesh/Bangladéš 2. Sending organization/ Organización del solicitante/ Vysílající organizace -

3. Full Name (according to passport)/ Apellido y nombre (como figura en el pasaporte)/ Úplné jméno (dle pasu) ISLAM Surname/ Apellido/ Příjmení: First and Middle Name(s)/ Nombre y segundo nombre/ Jméno a druhé jméno: 4. Sex/ Sexo/ Pohlaví Male/Muž TASIN Photo Fotografía Foto 3,5 x 4,5 cm

5. Date of birth/ Fecha de nacimiento/ Datum narození 17.4.1996

6. Place of birth (country)/ Lugar de nacimiento (país)/ Místo narození (stát) Bangladesh 8. Personal e-mail/ E-mail personal/ Osobní e-mail arnab.tasin17@gmail.com

7. Place of birth (city)/ Lugar de nacimiento (ciudad)/ Místo narození (město) Dhaka 11. Type of study/ Tipo de estudios/ Typ studia

Bachelor's study programme in Czech language/Bakalářský studijní program v českém jazyce 12. Subjects (fields) of study in Czech language/ Carreras (epecialización) de estudios en la lengua checa/ Obory v českém jazyce Power Engineering/Energetika Technical Subjects/Technické obory

13. Alternate subject (field) of study for study in Czech language/ Carrera opcional para estudiar en la lengua checa/ Náhradní oblast/obor studia pro studium v českém jazyce Computer Science 14. Subject studied in the Czech Republic/ Carrera estudiada en la República Checa/ Obor studovaný v ČR Subject/ Carrera/ Obor: University/ Universidad/ Škola: Faculty/ Facultad/ Fakulta: ----------

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15. Study programmes in English language/ Programas de estudios en la lengua inglesa/ Studijní programy v anglickém jazyce Folow-up Master's study programme in English language/ Continuación del programa del máster en ingles/ Navazující magisterský studijní program v anglickém jazyce Study programme/ Programa de Estudios/ University/ Universidad/ Škola: Faculty/ Facultad/ Fakulta: Studijní program: ----------

Subject/ Carrera/ Obor:

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Alternate Folow-up Master's study programme in English language/ Continuación del programa del máster en ingles opcional/ Náhradní navazující magisterský studijní program v anglickém jazyce Study programme/ Programa de Estudios/ University/ Universidad/ Škola: Faculty/ Facultad/ Fakulta: Studijní program: ----------

Subject/ Carrera/ Obor:

----

Doctoral study programme in English language/ Programa del Doctorado en ingles/ Doktorský studijní program v anglickém jazyce Study programme/ Programa de Estudios/ University/ Universidad/ Škola: Faculty/ Facultad/ Fakulta: Studijní program: ----------

Subject/ Carrera/ Obor:

----

Alternate Doctoral study programme in English language/ Programa de Estudios de Doctorado en ingles opcional/ Náhradní doktorský studijní program v anglickém jazyce Study programme/ Programa de Estudios/ University/ Universidad/ Škola: Faculty/ Facultad/ Fakulta: Studijní program: ----------

Subject/ Carrera/ Obor: 16. Marital status/ Estado civil/ Rodinný stav Single/Svobodný/á 17. Passport/ Pasaporte/ Pas No./ Número/ Číslo: ----

----

Issue date/ Fecha de expedición/ Datum vydání: ..

Valid till/ Fecha de expiración/ Platnost do: ..

18. Current permanent residence/ Domicilio permanente actual/ Trvalé bydliště Street address/ Calle, número de casa/ City/ Ciudad/ Město: Ulice, č.p.: Banamalipur, Banamalipur Faridpur

Postcode/ Código postal/ PSČ: Boalmari

Country/ País/ Stát: BANGLADESH

19. The address of permanent residence in the last 2 years at least/ Dirección del domicilio permanente en los últimos 2 años/ Adresa trvalého bydliště minimálně 2 roky zpět Street address/ Calle, número de casa/ City/ Ciudad/ Město: Postcode/ Código Postal/ PSČ: Country/ País/ Stát: Ulice, č.p.: 1. 20/1, Lake Circus, Kalabagan 2. ---3. ---Dhaka ------1205 ------Bangladesh -------

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20. Current occupation (study)/ Empleo actual (estudios)/ Současné zaměstnání (studium) Position and description of work tasks (field of study)/ Puesto y descripción del trabajo (orientación de estudios)/ Pozice a popis pracovní náplně (studijního zaměření): Bachelor of Business Administration

Name and address of the employer (educational institution)/ Nombre y dirección del empleador (centro educativo)/ Název a adresa zaměstnavatele (vzdělávací instituce) Name/ Nombre/ Název: Street address/ Calle, número de casa/ Ulice, č.p.: City/ Ciudad/ Město: Institute of Business Administration, University of Dhaka ---Dhaka

Country/ País/ Stát: Bangladesh

21. The highest achieved level of education, documented by a diploma or similar certificate/ El nivel de estudios alcanzados, documentado por un diploma o documento parecido/ Nejvyšší stupeň dosaženého vzdělání, doložený diplomem nebo jiným dokladem Secondary education/Středoškolské vzdělání 22. Education/ Historial académico/ Vzdělání Educational institution/ Centro educativo/ Vzdělávací instituce Basic education Government Educación primaria Laboratory High Základní vzdělání School Secondary education Notre Dame Educación secundaria College Středoškolské vzdělání Bachelor's study programme Programa de Bachiller (licenciatura) Bakalářský studijní program Master's study programme Programa de Máster Magisterský studijní program Doctoral study programme Programa de Doctorado Doktorský studijní program Others Otros Jiné ----

from to desde hasta od do

Field of study/ Carrera de estudios/ Obor studia

Degree/diploma Título/diploma Titul/diplom

January, 2001May,2011 July,2011August,2013 ----

Science

SSC

Place of the school (city, country)/ Lugar de la escuela (ciudad, país)/ Sídlo školy (město, stát) Dhaka, Bangladesh

Science

HSC

Dhaka, Bangladesh

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23. Language skills/ Conocimiento lingüístico/ Jazykové znalosti 0 zero knowledge/ sin conocimiento/ bez znalosti 1 elementary knowledge/ conocimiento básico/ základní znalost 2 pre-intermediate/ nivel medio/ mírně pokročilý 3 intermediate/ nivel avanzado/ středně pokročilý 4 upper-intermediate/ nivel superior/ velmi pokročilý 5 advanced/ conocimiento excelente/ výborná znalost Oral skills/ Expresión oral/ Writing/ Expresión escrita/ Ústní projev Psaní ------4 ---------------3 ----------------

Languages/ Idiomas/ Jazyky Czech/ Checo/ Čeština English/ Inglés/ Angličtina Spanish/ Español/ Španělština French/ Francés/ Francouzština Russian/ Ruso/ Ruština Other/Otro/Další Other/Otro/Další

Reading/ Comprensión escrita/ Čtení ---3 ----------------

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24. Foreign travels and study/research stays in the last 5 years/ Viajes al extranjero y estancias de estudios/investigación en los últimos 5 años/ Zahraniční cesty a studijní/výzkumné pobyty za posledních 5 uplynulých let Year/ Country/ Place/ Purpose/ Año/ País/ Localidad/ Finalidad de estancia/ Rok Země Místo Účel ------------1 2 3 4 5 -------------------------------------------------

Length/ Duración/ Délka ----------------

25. Contact person/ Persona de contacto/ Kontaktní osoba Name/ Nombre/ Jméno: Street address/ Calle, número de casa/ Ulice, č.p.: 20/1, lake Circus, Kalabagan Md. Nurul islam Postcode/ Código postal/ PSČ: 1205 Country/ País/ Stát: Bangladesh

City/ Ciudad/ Město: Dhaka Tel.: 8801715015677

E-mail: nawshin.nishi12@gmail.com

26. Contact address/ Dirección de contacto/ Kontaktní adresa Street address/ Calle, número de casa/ Ulice, č.p.: 20/1, lake Circus, Kalabagan Postcode/ Código Postal/ PSČ: Country/ País/ Stát: 1205 Bangladesh

City/ Ciudad/ Město: Dhaka E-mail: arnab.tasin17@gmail.com

Tel.: 8801683021493

27. Motivation letter (max. 1000 characters)/ Carta de motivación (máx. 1000 charácteres)/ Motivační dopis (max. 1000 znaků) My mom wanted me to be an engineer since my childhood. Back then, I didn’t really know what it meant. It is after I got into high school I realized how much I love applied sciences. And just like that mom’s wish became my dream. After finishing high school, I applied in the best engineering school in my country but I didn’t get in. It was always in my mind that I have to learn engineering from the bests of institutions. So, I got into the best business school in my country as a backup and decided to try for engineering institutions outside of Bangladesh. Czech Republic is very popular for higher studies in engineering. That is what drove me to make this application. Now this may not be considered a plan but I want to finish my Bachelor & Masters in power systems and then come back home. Because there isn’t really many good power engineers in Bangladesh and I would love to add to that. I also want to get my PhD and maybe even teach here to help create a new generation of good engineers.

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I, the undersigned, Yo, abajo firmado/a, Já, níže podepsaný/á, hereby confirm that the information given in this application is true and complete to the best of my knowledge and belief,/ confirmo que todas las informaciones contenidas en esta solicitud son verdaderas y completas y están de acuerdo con mi mejor conciencia,/ stvrzuji, že informace uvedené v této žádosti jsou pravdivé a úplné podle mého nejlepšího vědomí a svědomí, agree that my personal data given in this application form and its annexes would be processed while dealing with my application for granting the scholarship and stored for the needs of the Ministry of Education, Youth and Sports of the Czech Republic and the Ministry of Foreign Affairs of the Czech Republic in accordance with the applicable provisions of Act No. 101/2000 Coll., on personal data protection and modification of some acts, as amended./ estoy de acuerdo con que mis datos personales expresados en este formulario y en sus anexos serán utilizados para tramitar mi solicitud de la concesión de la beca y estoy de acuerdo que serán conservados para el uso del Ministerio de Educación, Juventud y Deporte de la República Checa y del Ministerio del Exterior de la República Checa, conforme con los reglamentos de la ley n 0 101/2000 del Código,de protección de datos personales y de los cambios de algunas leyes, según los reglamentos posteriores./ souhlasím s tím, aby mé osobní údaje uvedené v tomto formuláři žádosti a přílohách k němu byly zpracovány při vyřizování této mé žádosti o přiznání stipendia a uchovány pro potřeby Ministerstva školství, mládeže a tělovýchovy České republiky a Ministerstva zahraničních věcí České republiky v souladu s příslušnými ustanoveními zákona č. 101/2000 Sb., o ochraně osobních údajů a o změně některých zákonů, ve znění pozdějších předpisů. I am not a citizen of the Czech Republic or of any other European Union member state./ no soy el ciudadano de la República Checa ni de ningún otro país que es miembro de la Unión Europea./ nejsem občanem České republiky ani jiného státu Evropské unie.

Place/ Localidad/ Místo

Date/ Fecha/ Datum

Signature/ Firma/ Podpis

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Předkládaná dokumentace
Číslo 1 Dokument Formulář žádosti o stipendium vlády ČR (Přihláška), s vlepenou fotografií, podepsaný Životopis (informace o studiu, zaměstnání) 2 Fotokopie cestovního dokladu, pokud byl vydán 3 Prohlášení o akceptaci podmínek poskytování stipendií vlády České republiky (vlastnoručně podepsané!) 4 Prohlášení o akceptaci podmínek poskytování zdravotní péče (vlastnoručně podepsané!) 5 Čestné prohlášení o návratu do vysílající země po ukončení studia (vlastnoručně podepsané!) 6 Úředně ověřená kopie rodného listu s úředním překladem do českého jazyka 7 Lékařské potvrzení o zdravotním stavu kandidáta, ne starší dvou měsíců, s úředním překladem do angličtiny nebo češtiny 8 Úředně ověřená kopie zahraničního vysvědčení (dokladu o ukončeném středoškolském vzdělání) s úředně ověřeným překladem do českého jazyka, vyhotoveným tlumočníkem zapsaným v ČR do seznamu znalců a tlumočníků Doklad o obsahu a rozsahu vzdělávání absolvovaného v zahraniční škole (výpis předmětů v jednotlivých ročnících středoškolského studia s jejich časovou dotací, příp. potvrzení o rozsahu praktického vyučování) s úředně ověřeným překladem do českého jazyka, vyhotoveným tlumočníkem zapsaným v ČR do seznamu znalců a tlumočníků Doklad o skutečnosti, že škola je uznána státem, podle jehož právního řádu bylo zahraniční vysvědčení vydáno, za součást jeho vzdělávací soustavy, pokud ze zahraničního vysvědčení tato skutečnost nevyplývá s úředně ověřeným překladem do českého jazyka, vyhotoveným tlumočníkem zapsaným v ČR do seznamu znalců a tlumočníků

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