· Web viewIf you had other responsibilities, not described above, mention those in the table below ... Parasitology. Protozoology. Virology. Field of interest

Tel +27 (0)12 420 4111 Fax +27 (0)12 420 4555www.up.ac.zaUniversity of Pretoria, Private Bag X20,

Tel +27 (0)12 420 4111 Fax +27 (0)12 420 4555www.up.ac.zaUniversity of Pretoria, Private Bag X20,

Room 2-37.2, Paraclinical BuildingDepartment of Veterinary Tropical Diseases (DVTD)Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort, 0110, South Africa

PRE-APPLICATIONInstitute for Tropical Medicine

University of Pretoria, Faculty of Veterinary ScienceCollaborative degree programme

Master of Science in Tropical Animal Health (MSc TAH)Complete this form accurately and legibly (typed).

Incomplete or illegible applications may not be consideredPlease ensure that e-mail addresses are correctly and eligibly entered

Note: The selection committee will advise successful candidates at which Institute they will be registered

SEND YOUR COMPLETED FORM TO:Department of Veterinary Tropical DiseasesFaculty of Veterinary ScienceUniversity of PretoriaPrivate Bag X04, Onderstepoort, 0110, SOUTH AFRICA

+27 12 529 8384 +27 12 529 8312 [email protected]

Institute of Tropical MedicineSecretariat MSTAHNationalestraat 1552000 Antwerpen, BELGIUM

+32 3 247 63 52 +32 3 247 62 68 [email protected]

DEADLINE FOR SUBMISSION:31 August preceding the year of registration

(Academic year is January to December)

Supporting documentation check list

1. Curriculum Vitae

2. Certified copies of ALL relevant previous qualifications

3. Certified copies of academic record (subjects and results)

4. Identity document or Passport

5. South African Qualifications Authority (SAQA) - see heading 11

6. Language proficiency (TOEFL) - see heading 11

Tel +27 (0)12 420 4111 Fax +27 (0)12 420 4555www.up.ac.zaUniversity of Pretoria, Private Bag X20,

Tel +27 (0)12 420 4111 Fax +27 (0)12 420 4555www.up.ac.zaUniversity of Pretoria, Private Bag X20,

Room 2-37.2, Paraclinical BuildingDepartment of Veterinary Tropical Diseases (DVTD)Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort, 0110, South Africa

1. PERSONAL INFORMATION

Family name Maiden namefor married woman)

First names

Date of birth (dd/mm/yyyy)

Country of birth Nationality

Gender Male Female Marital status: Single Married Separated Divorced Widow/Widower

Postal address (where you can be reached during the next 12 months) (changes in address must be communicated immediately)

Email Telephone

Professional address

Email Telephone

2. EDUCATION2(A) University/higher education - undergraduate and postgraduate degrees (add lines where needed)

Institution Location & main language of instruction

Major field of study Qualification (degree)& date award

Datesdd/mm/yyyy(start– end)

Internship (as part ofthe education)

Location & main language of instruction

Field of activities Datesdd/mm/yyyy(start– end)

2(B) Additional training (Seminars excluded)

Institution Location & main language of instruction

Name of training course

Qualification (degree/certificate) &

date award

Datesdd/mm/yyyy(start– end)

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3. EMPLOYEMENT RECORD (in reverse chronological order; use additional sheets if necessary)

Present or most recent position

Employer

Locality (town & country)

Type of organisation Public Private NGO Other specify

Job title

Country and locality of job

Level of intervention Central Regional/Provincial District

Years of service(starting and ending date, dd/mm/yyyy)

from until

Type of work and proportion () (total should be 100%)

research … % teaching … % policy … % clinical work … %

program management … % Other-specify … %

Description of your present work, indicating your personal responsibilities (confine yourself to the given space)

Previous position

Employer

Institution Locality (town & country):

Type of organisation Public Private NGO Other specify

Job title

Country and locality of job

Level of intervention Central Regional/Provincial District

Years of service(starting and ending date, dd/mm/yyyy)

from until

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Type of work and proportion () (total should be 100%)

research … % teaching … % policy … % clinical work … %

program management … % Other-specify … %

Description of your past work, indicating your personal responsibilities (confine yourself to the given space)- -column will increase as you add info

Other (professional activities or past jobs)

If you had other responsibilities, not described above, mention those in the table below (only if 6 months duration minimum).The Selection Committee may ask additional information when assessing your application

Function (job title) Place/Country Description Period (start and end dates)

4. MOTIVATION (confine yourself to one page)

Why do you wish to attend the course, focusing on:a) Fields of study which have your particular interestsb) Where and how do you expect to apply the acquired knowledge

column will increase as you add info

Give a short description and analysis of a problem that you faced in your professional activity.(The problem should clearly be linked with the field of study you are applying for)-column will increase as you add info

5. REFERENCES

Give three references (no relatives or in-laws) who know your personality and your professional capacities

Full name and position of referees Contact details

Name E-mail

Position Telephone

Your relationship to this person Address

Page 4 of 11

Full name and position of referees Contact details

Name E-mail

Position Telephone

Your relationship to this person Address

Full name and position of referees Contact details

Name E-mail

Position Telephone

Your relationship to this person Address

6. LANGUAGE : ASSESSMENT OF COMPETENCE IN ENGLISH

For candidates from countries where the course language is different from their mother tongue, an officially recognised proficiency language certificate is mandatory: TOEFL/IELTS/British Council. The minimum requirement is a TOEFL score 580 (paper based), 230 (computer based), or an IETLS of 6.5. or equivalent unless you had a higher education in English.

7. PUBLICATIONS

List your publications with full references-column will increase as you add info

8. SOURCE OF FUNDING (Applicants are strongly advised to explore several sources of scholarships and to keep the course secretariat informed about the outcome of their applications)

1) I intend to submit an application for financial support at :

Name of organisation

Name of organisation

2) I have submitted an application for financial support :

Name of organisation

Contact person Date

Name of organisation

Contact person Date

3) Self-funded Yes No Research funds available Yes No Amount

Page 5 of 11

4) I plan/want to submit a scholarship application to the Belgian Directorate General for Development Co-operation (DGD)

Yes No (if yes, complete and sign page 8 of this application form)

CONDITIONS : Be aged under 46 Be a national of one of the following DGD beneficiary countries :

Afghanistan, Algeria, Angola, Bangladesh, Benin, Bolivia, Brazil, Burkina Faso, Burundi, Cambodia, Cameroon, China, Colombia, Cuba, Dominican Republic, DR Congo, Ecuador, El Salvador, Ethiopia, Gambia, Guatemala, Guinee, Guinee-Bissau, Haiti, Honduras, India, Indonesia, Ivory Coast, Kenya, Laos, Madagascar, Mali, Mauritania, Morocco, Mozambique, Namibia, Nepal, Nicaragua, Niger, Palestinian Territories, Peru, Philippines, Rep. of South-Africa, Rwanda, Senegal, Surinam, Tanzania, Togo, Uganda, Vietnam, Zambia, Zimbabwe

Have you applied for a DGD fellowship for this academic year at another institution? Yes No

If yes, specify

Have you received a DGD fellowship in the past? Yes No

If yes, specify the academic year, period of the course, institution, name of the course and field of study

5) I want to submit an application for partial financial support to the Institute of Tropical Medicine (for EU applicants only)

Yes No (if yes, enclose your application letter)

6) Website for other opportunities http://www.up.ac.za/fees-and-funding/article/262104/postgraduate-funding

NOTE : YOUR ACADEMIC SELECTION FOR THE COURSE DOES NOT GUARANTEE THE AWARD OF ANY SCHOLARSHIP

9. SOURCE OF INFORMATION

I learned about this course through ( where appropriate)

brochure an advertisement website the Belgian / South African Embassy

a staff member alumni other

I certify that the information contained in this application form is true, complete and correct

Date Signature

10. RESEARCH

Field of interest ( ONLY 1 or 2)

Bacteriology Ectoparasitology Helminthology Immunology

Molecular Biology Parasitology Protozoology Virology

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Field of interest - DVTD Research Themes ( ONE of the following themes)

Arthropod-borne viruses

Bluetongue virus

African horse sickness virus

Rift valley fever virus

Parasite/host/vector interaction in southern Africa

Ticks and tick-borne diseases

Theileriosis

Anaplasmosis

Babesiosis

Ehrlichiosis`

Tsetse and trypanosomosis

Endoparasites of domestic animals and wildlife

Coccidiosis

Filariasis

Helminths of small ruminants

One Health in Transfrontier Conservation Areas in southern Africa

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Zoonoses

Bacterial

Anthrax

Tuberculosis

Brucellosis

Parasitic

Toxoplasmosis

Rickettsial infections

Viral

Rift valley fever virus

Infectious diseases at the wildlife/domestic animal interface

Foot-and-mouth disease

Malignant catarrhal fever

Rabies

Canine distemper

Possible research project (if any) column will increase as you add info

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11. IMPORTANT INFORMATION

Note 1 : PROJECT FUNDING

Web-based MSc required fundingThis project may be a retrospective study, or embrace work you have already done, but not published, or work that you are currently busy with, or it can involve a survey of some kind, or a new project discussed with and approved by your supervisor. Depending on the type of project it can be at almost no cost or, if a new project must be done, the cost could range from R 50 000 to R 70 000 (project only).

Note 2 : STUDENTS WHO HAVE COMPLETED THEIR STUDIES AT UNIVERSITIES OUTSIDE SOUTH AFRICA

SAQAPostgraduate applicants must have their qualifications evaluated by SAQA (South African Qualifications Authority).

Application and more information : http://www.saqa.org.za/

TOEFL : Language proficiency (TOEFL test)In order for international students to fit into both the academic and social environment, they need to be conversant in English.All international applicants whose first language is not English, will have to write and pass the TOEFL test.

Application and more information : http://www.ets.org/toefl/

Note 3 : COMPUTER LITERACY

The newer and more robust your computer, the faster and more efficient you will be as an online student. This means the more access power you have in your computer, modem, and Internet service provider, the more efficient you’ll be.

Note: Access to a computer at work or at home is required - working from an Internet cafe is not adequate when you register for the degree programmeThe minimum computer specifications you should consider are:

Windows XP, Vista, 7,8 or 8.1 Apple OS X 10+ or Linux Broadband: ADSL or 3G Browsers: Internet Explorer 9+ or newest Chrome or Mozilla

You will also need an Internet Service Provider to connect you to the Internet.

The minimum computer skills required are:The web-based nature of the modules implies that you require certain basic computer skills in order to successfully participate in the online module for CPD. Competence in written English is also important. Word processing: Create, edit and save an MSWord document on your computer E-mail: Receive, open and send e-mail, and attach documents to an e-mail message Using the internet: Use a browser (e.g. Internet Explorer) to access the internet, conduct searches, download and upload

documents Installing software: Install and uninstall software on your computer PowerPoint presentations: For some modules you will be required to create a basic MS PowerPoint presentation

I,

hereby confirm that I comply with the minimum requirements as stated above.

Signature Date

Page 9 of 11

Room 2-37.2, Paraclinical BuildingDepartment of Veterinary Tropical Diseases (DVTD)Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort, 0110, South AfricaTel +27 (0)12 529 8384Fax +27 (0)12 529 8312Email [email protected]

12. Annexure - Provisional indication of module selection

Indicate modules you wish to select over the two years by next column and indicate which year you intend to do it.

YEAR 1 (2016)

1st semesterCore modules

Year Modules UPcredits

ITMcredits Credits

2016

Induction: A two week orientation at DVTD and Hans Hoheisen. Will include sessions on key computing, library, study and research skills. Aspects of the Research Methodology (3 of the 9 credits) (1 of the 3 ECTS) and One Health: Basic concepts (6 of the 12 credits) (2 of the 4 ECTS) modules will also be presented (face-to-face) during this time.

2016 Research methodology 9 3

2016 One Health: Basic concepts 12 4

2016 Basic Epidemiology 12 4

2016 Laboratory Diagnostics 9 3

Sub-total credits

Core 42Electives 48Dissertation (research) 90TOTAL 180

2nd semesterTheory-based elective modules

Year Modules UPcredits

ITMcredits Credits

Advanced One Health 12 4

Animal Health Management: High Impact and EmergingDiseases

12 4

Ticks and Tick-borne diseases 9 3

`

Skills-based elective modules(a maximum of two may be elected)

Applied Veterinary Bacteriology 9 3

Applied Molecular Biology 9 3

Applied Serology 9 3

Applied Veterinary Virology 9 3

Selected Tick identification 9 3

Applied Veterinary Helminthology 9 3

Applied Epidemiology 9 3

Sub-total credits

YEAR 2 (2017)

1st semesterTheory-based elective modules

Year Modules UPcredits

ITMcredits Credits

Advanced One Health: Policy 12 4

Advanced One Health: Public Health 12 4

Advanced Epidemiology 12 4

Surveillance and Survey Methodology 12 4

General Vector-borne diseases 9 3

Sub-total credits

2nd semesterTheory-based elective modules

repetition of previous year to make provision for the 2017 intake Year Modules UP

creditsITM

credits Credits

Advanced One Health 12 4

Animal Health Management: High Impact and Emerging Diseases

12 4

Ticks and Tick-borne diseases 9 3`

Skills-based elective modules(a maximum of two may be elected)

Applied Veterinary Bacteriology 9 3

Applied Molecular Biology 9 3

Applied Serology 9 3

Applied Veterinary Virology 9 3

Selected Tick identification 9 3

Applied Veterinary Helminthology 9 3

Applied Epidemiology 9 3

Sub-total credits

TOTAL

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