Please email Bianca van Zundert, program coordinator, at for any additional information.

Application Form ( print-friendly version )

APPLICATION DEADLINE: September 15, 2008

All fields marked with a* are required.

Prefix:
First (or Given) Name: *
Middle Initial:
Last (or Family) Name: *
Date of Birth:
Nationality: *
Company:
Job Title:
Address:
City: *
State/Province/Country *
Zip/Postal Code: *
Work: *
Fax:
Mobile:
Email: *
Company website:


Application Form Continued
Education
Institution    
Location    
Degree    
Major    
Graduation Year    
Institution    
Location    
Degree    
Major    
Graduation Year    
Institution    
Location    
Degree    
Major    
Graduation Year    

Please attach (Word, PDF or RTF) a current CV that includes publications, patents, awards, professional presentations and references.
*

It is important to spend some time on this section as it will be used by the Carnegie Mellon assessment panel in considering your application to the EECP. The way you complete this section can have a major impact on your eligibility for the course. We would request you complete the following sections in as much detail as possible:

Which of the following three headings area best describe the reasons you are applying for the program?
*

Each course costs US$3,000 or 10,950 QR. The total is US$12,000 or 43,800 QR for the entire program

Please indicate by ticking the box below:

  • If you are paying the fee from your own resources
  • If your company is sponsoring or you wish CMU to assist you in securing your companies sponsorship .(CMU is currently actively approaching companies/ organisations in Qatar to secure their support and sponsorship of employees on the program)
  • If you intend to start a technology company in Qatar please indicate if you wish to be considered for a scholarship from Qatar Science & Technology Park. Please note that scholarships numbers are limited and will be subject to a separate scholarship process subsequent to your acceptance on the program. (Please enquire further from Dr. Dobashi: mohamedd@qatar.cmu.edu )

If your company is sponsoring you, please provide the contact information of your sponsor:

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