Full name and title (Mr./Ms.)

Nationality and date of birth (DD/MM/YY)

Place of birth (country, city)     

Second nationality (if any)

Permanent address

Email address

Place of current residence (country, city)          

Telephone number

Current address with ZIP/postal code

Educational institutes attended

1.

2.

3.

Diploma/certificate received

1.

2.

3.

Passport number

Passport country and authority of issue

Date of expiry

Place of applying and receiving Russian visa (country, city with a Russian Consulate)  

Employer information (organisation name and full address (country, city, address)    

Job title

Contact details (telephone, e-mail)

How did you hear about the MSA programme? Please be as specific as possible. If applicable, provide details of any education counsellors or agencies you have consulted before applying for the MSA.

Languages

Are you a native English language speaker?  Yes / No

If not, what is your native language?

If English is your second language, how would you describe your English skills?  (1=poor; 5=excellent)

Speaking:              1              2              3              4              5

Reading:                1              2              3              4              5

Writing:                  1              2              3              4              5

For how many years have you studied English? 

Which MSA programme modules are you particularly interested in (in order of preference)?

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