رئاسة الوزراء
المجلس الاعلى للشباب
استمارة التقديم
الى نوادي الروبوت والذكاء الصناعي
(*) Indicates required question
Personal and contact details :-
First name *
Father's name *
Surname *
Gender *
Male
Female
Date of Birth *
Email *
Phone number *
Emergency contact's name, phone number and email *
Current address *
Youth Forum name
Al-Khwarizmi(Sadr city.)
Binouk
Ameria
Previous qualification(s) and experience
List all previous undergraduate and postgraduate qualifications
What type of qualification do you have? (Please tick all that apply) *
Secondary school
BSc or BEng
MSc or other postgraduate degree (please specify)
PhD
Other
For the Secondary school qualification, please specify: *
1. The title of the qualification,
2. name of school,
3. date of award,
4. grade,
5. country of study.
For the Bachelor qualification, please specify:
1. The title of the qualification,
2. name of institution,
3. date of award,
4. grade,
5. country of study.
For the MSc (postgraduate) qualification, please specify (if applicable):
1. The title of the qualification,
2. name of institution,
3. date of award,
4. grade,
5. country of study.
For the PhD qualification, please specify (if applicable):
1. The title of the qualification,
2. name of institution,
3. date of award,
4. grade,
5. country of study.
Work Experience
Please state any relevant work experience in the last three years
Current job title
Name and location of organization
from
Previous job title
Name and location of organization
from
to
Professional practice and special considerations
Please list any membership of a professional body e.g. IEEE, Iraqi Engineers Association, etc...
Professional registration (registering body and registration number)*
Software skills achieved*
Programming skills achieved *
Access to learning technology (please tick all that apply)*
Desktop PC
Laptop
Tablet
Mobile phone
None
Please state any special considerations or learning adjustments you may require (if applicable)
Personal statement
Please write a statement justifying any relevant expertise that qualifies you for this course (350-500 words)*
References
Please give the name, institution, email address and telephone number for each referee
Referee 1*
Referee 2*
Supporting documents *
Please upload a scanned original copy of your documents including the Iraqi ID card, university qualifications and English languages certificate all collected in four PDF files, alongside a Face photo.
The Face photo should be taken against a plain background and should be uploaded as an image.
Iraqi ID card (PDF) Max(500 KB)*
Transcripts (PDF) Max(500 KB)*
certificates (PDF) Max(500 KB)
Other Files - CV (PDF) Max(500 KB)
Face photo (JPG, JPEG, PNG , GIF) Max(500 KB)*
Declarations
I certify that: *
the information supplied in this application is correct.
I have graduated within the last five years.
I have read the PGDip in Industry 4.0 skills guidance notes.
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