MINISTÉRIO DA DEFESA
        COMANDO DA AERONÁUTICA

ADMISSION
Sep. 01 to Oct. 16

 INSTITUTO TECNOLÓGICO DE AERONÁUTICA 
PRÓ-REITORIA DE PÓS-GRADUAÇÃO 
   
FICHA DE INSCRIÇÃO	

Course:     Master      Doctorate		              1st Application   Re-application
Dedication:  Regular student        Special student

Program*:_________________________________     Area*:_____________________________________________

1.	PERSONAL DATA

3 x 4 cm Photo

FULL NAME:  ......................................................................................................................	
 ..........................................................................................................................................................         	
Marital Status ......................................................   Gender:         Male          Female                            
Birth Date:(dd/mm/yyyy)........... / ........... / .............. City:.............................Country:...................	
Father`s Name: ...............................................................................................................................                     Mãe: Mother`s Name: .............................................................................................................................
FULL ADDRESS:

.....................................................................................................................................................................................
.....................................................................................................................................................................................                        
Zip Code: ...........................Country:............................................................................................................................
Phone.: (........).................................... Fax: (........)...........................E-mail.:................................................................

IDENTIFICATION:	
Passport number:
Passport expiration date: __ / __ / ____	RNE or CIE number**:
Expiration date: __ / __ / ____	
** RNE(Foreign National Record) is a record for temporary or permanent residents issued by the Brazilian Government.
CIE is the Foreigners ID card issued by the Brazilian Government.

2.COURSE DEDICATION
 I have a scholarship from:	Course dedication:     Full time      Partial time	
  I would like to apply for a scholarship.	The candidate acceptance does not mean commitment by ITA to grant scholarship.	
  I do not need a scholarship		

3. QUALIFICATION
Higher level of academic degree:	Obtained in (year):	
Institution of higher academic degree:	Country:	
Degree area:	

4. PROFESSIONAL RECORD (indicate in chronological order starting with the most recent employer)
INSTITUTION	from	to	Position/Professional Activities	

* See Programas and Aereas in http://www.ita.br/posgrad  For help contact Area coordinator. Lectures are given in Portuguese.

5. KNOWLEDGE OF FOREIGN LANGUAGES (TICK WITH AN X)
LANGUAGE	READ	SPEAK	WRITE	LISTENING	
English					
Portuguese					
Spanish					
Other (specify):					

6. IN CASE YOU HAVE TAKEN GRADUATE COURSES/SUBJECTS AT ITA OR IN OTHER INSTITUTIONS 
INSTITUTION	CODE	COURSE/SUBJECT NAME	YEAR 	GRADE	

					

7. PROFESSIONAL REFERENCES (indicate two professionals)
Full name:	
Institution:	
Phone: (          )                                   Fax: (          )                                                      e-mail:  	
Professional relationship (advisor, employer, etc) :	
	
Full name::	
Institution:	
Phone: (          )                                   Fax: (          )                                                      e-mail:  	
Professional relationship (advisor, employer, etc):	

8. AREA OF INTEREST (briefly describe the initial proposal for your research):

	

9. ADDITIONAL INFORMATION

CHECKLIST OF REQUIRED DOCUMENTS (DO NOT MARK – RESERVED FOR ITA´S OFFICE USE ONLY)
(     )	Admission Form	(      )	Two Academic Recommendation Letters	
(     )	3x4 cm Photo	(     )	Complete Transcripts of Grades (certified copy)	
(     )	Passport (certified copy of book number and photo page)	(     )	Undergraduate/Graduate(Master) Diploma(certified copy)	
(     )	RNE or CIE (certified copy)	(     )	Proficiency Certificate in English
   (only for doctoral applicants) - (certified copy)	
(     )	Curriculum Vitae.	(     )	Initial Research Proposal ***(up to 3 pages)	
***The Initial research proposal must contain a description of interest area, motivation, research purpose and work plan.

City, (day/month/year) _________________________________________________

 ________________________________________________
Signature