Application for Admittance to the Doctoral Examination for Dr. rer. biol. hum.

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Maike Hofer
vor 5 Jahren
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1 Application for Admittance to the Doctoral Examination for Dr. rer. biol. hum. 1. I hereby apply for admission to the doctoral examination for Dr. rer. biol. hum. (doctoral degree in human biology) Name Maiden name First name(s) please underline name used Place of birth Date of birth Nationality Address Telephone number address Matriculation number 2. The title of my thesis is: Title Institution where the thesis was conducted The doctoral supervision agreement and the consent of the institution s director (if needed, see 4 Paragraph 3 Examination Regulations) are attached (one copy each). 3. I passed the predoctoral examination on. The confirmation is attached. 4. Confirmation of a 2-year minimum employment at a scientific or clinical institution of the LMU s Medical Faculty is attached. Application human biology Date:

2 MEDICAL FACULTY LMU MUNICH PAGE 2 OF 4 5. Publications The submitted thesis has not been published to date. The submitted thesis or parts thereof have been published in Title of journal(s) 6. Attempted doctoral examinations No attempted doctoral examinations to date Doctoral examination on at the faculty of/in Title of this thesis 7. Certificate of good conduct An official certificate of good conduct (not older than 8 weeks) is attached or proof that no more than 3 months have passed since exmatriculation or a confirmation from the employer on employment in civil or public service. 8. Native language My native language is German My native language is not German. I have sufficient proficiency of spoken and written German. A confirmation is attached. 9. The following documents are attached to this application: Dissertation 2-fach in gebundener Ausgabe Dissertation 1-fach in PDF-Format Eidesstattliche Versicherung (muss in der Dissertation eingebunden sein) Erklärung, dass gebundene und elektronische Fassungen der Dissertation übereinstimmen Bestätigung Autoren (bei kumulativer Dissertation) Votum informativum Bestätigung über die bestandene Promotionsvorprüfung Nachweis der zweijährigen Tätigkeit amtl. Führungszeugnis o. aktuelle Immatrikulationsbescheinigung o. Bestätigung Arbeitgeber ggf. Bestätigung über deutsche Sprachkenntnisse Doktoranden-Betreuungs-Vereinbarung Formblatt Münchener Universitätsgesellschaft ggf. Erklärung bei externem Studium ggf. ethisch-rechtliche Unbedenklichkeitserklärung Application human biology Date:

3 MEDICAL FACULTY LMU MUNICH PAGE 3 OF 4 Mir ist bekannt, dass die Zulassung zur Promotion zu versagen ist, wenn die Unterlagen unvollständig oder die Angaben unrichtig sind. Ich bin darüber informiert, dass ich zur Führung des Doktortitels erst mit Aushändigung der Promotionsurkunde berechtigt bin. Ort, Datum Unterschrift Application human biology Date:

4 MEDICAL FACULTY LMU MUNICH PAGE 4 OF 4 Not to be filled out by applicant! Eingang Promotionsantrag: Thesis (2-fold), bound Thesis (1-fold) in PDF-format Affidavit (must be bound in the thesis) Confirmation of accordance between bound and electronic versions of the thesis Confirmation of co-authors (for cumulative dissertations only) Supervisor s expert evaluation Confirmation of successfully completed predoctoral examination Confirmation of 2-year employment Official certificate of good conduct or current certificate of matriculation or confirmation by employer If applicable, proof of German proficiency Doctoral supervision agreement Form Münchener Universitätsgesellschaft If applicable, Confirmation on external studies If applicable, ethical-legal clearance 1. expert evaluator: 2. expert evaluator: 1. co-evaluator: 2. co-evaluator Additional evaluator: determined on received on returned on Grade Durch den Promotionsausschuss am: festgesetzte Benotung: Bei Benotung mit summa cum laude Fakultätsrat verständigt am: Termin mündliche Prüfung - Fakultätsrat verständigt am: Mündliche Prüfung am: Ergebnis der mündlichen Prüfung: Berechnung der Gesamtnote: Note der Dissertation x 2 = plus mündl. Note = : 3 = Promotionsurkunde ausgefertigt am: Pflichtexemplare abgeliefert am: Promotionsurkunde ausgehändigt am: Application human biology Date:

5 Affidavit Surname, first name Street Zip code, town Country I hereby declare, that the submitted thesis entitled is my own work. I have only used the sources indicated and have not made unauthorised use of services of a third party. Where the work of others has been quoted or reproduced, the source is always given. I further declare that the submitted thesis or parts thereof have not been presented as part of an examination degree to any other university. Place, date Signature doctoral candidate Affidavit October 2013

6 Confirmation of congruency between printed and electronic version of the doctoral thesis Surname, first name Street Zip code, town Country I hereby declare that the electronic version of the submitted thesis, entitled is congruent with the printed version both in content and format. Place, date Signature doctoral candidate Congruency of submitted versions October 2013

7 Cumulative Dissertation Confirmation pursuant to 4a Paras. 3 and 5 Doctoral Degree Regulations for Dr. med., Dr. med. dent. and Dr. rer. biol. hum. and pursuant to 7 Para. 4 Doctoral Degree Regulations for Dr. rer. nat. at the Please note: for each published article, a separate Cumulative Dissertation form has to be submitted! Name of doctoral candidate Title of publication Journal (Name, issue, year, etc.) I hereby confirm that none of the articles submitted for this doctoral degree have been the subject of another (current or completed) dissertation. Signature of doctoral candidate By signing, the following co-authors confirm that: - the extent of their contributions (content-related and volume) in the publications submitted, - their agreement to the submission of the publications, and - the article in question is not the subject of another (current or completed) dissertation. Name of co-author Extent of contribution (content-related and volume) Signature of co-author Please list further authors on a separate page Cumulative dissertation Date:

8 Form for externally conducted thesis I hereby declare, that I have never been enrolled at the LMU Munich. For documentation (e.g. verified study periods for entitlement to a pension), the Dept. III.8 of the LMU Munich asks for the following information: Name, First name Date of birth Address Place, Date Signature External thesis October 2013

9 Form for the Münchener Universitätsgesellschaft Dear Sir / Madam, The Münchener Universitätsgesellschaft e.v. would like to win further friends and sponsors for the Ludwig-Maximilians-Universität München. In order to support this, the Doctoral Committee plans to forward your address to the Münchener Universitätsgesellschaft upon successful completion of your doctoral degree. Sincerely, signed Doctoral Committee Declaration I agree to have my address forwarded to the Münchener Universitätsgesellschaft. yes no Name, first name Address address Place, date Signature Münchener Universitätsgesellschaft October 2013

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