To the Chairperson of the Ph.D. Board of theSchool of Science and Technology of the University of Siegen

(via the appropriate department and the dean of the School)

Application to Start a Doctoral Procedure(Doctoral Application)

according to § 7 of the Regulations for a Doctoral Degree of June 8, 2017

Herewith I request,

(Family Name, Given Name, Academic Degree, Date of Birth)

(Address)

the initiation of a doctoral procedure to obtain a doctoral degree: Dr. rer. nat. Dr.-Ing. Dr. paed. Dr. phil.

The doctoral subject is:

The title of the dissertation is:

(title of the dissertation)

I suggest as reviewer (for external reviewers indicate associated institution):and

In addition to the reviewers, I propose as members of the doctoral committee:and

The documents listed overleaf are attached.

Siegen, the (Applicant signature)

Declaration of consent of the supervising university lecturer

I agree with the submission of the above dissertation. It is expected to meet the requirements of § 5, section 2 of the doctoral degree regulations.

As chairman, I propose:

Siegen, the (Signature of the university teacher)

Page 1 of 2

Page 2 of 2

Statements according to § 7 of the doctoral regulations of June 8, 2017

I hereby declare(,)

1. that I am aware of the doctoral regulations of June 8, 2017 and that they have beenrecognized and accepted by me.

2. that I did not apply for a doctoaral procedure at another university or school, either earlier orat the same time.

3. hereby on oath that I have made the present work without the unauthorized help of thirdparties and without the use of other, unmentioned aids. The data and concepts directly or indirectly taken over from other sources are indicated by stating the source. The work has not yet been submitted to another examination authority either in Germany or abroad in the same or similar form. No services of a doctoral or similar organization were used.

4. that there are no family relationships, first degree relatives, marriage, civil partnership, or marriage-likecommunity with the proposed members of the doctoral committee.

5. that my dissertation has used research results obtained in collaboration with the followingscientists (names, academic degrees and addresses):

(Applicant signature)

The following documents are attached:

1. Tabular Resume (§ 7, Abs. 2(d))2. Five printed copies of the dissertation (§ 7, Abs. 2(f))3. Proof of registration, not older than three months (§ 7, Abs. 2(l))4. Questionnaire for doctoral candidates (will be needed after the examination) (§ 7, Abs. 2(e))5. Summary in English and German (tips on application)6. Where applicable, proof of the additional benefits mentioned in the authorization. (§ 7, Abs. 2(c))7. If applicable, admission as a doctoral candidate and originals submitted for accreditation,

such as certified copies of documents or certificates, if returned to the applicant. (§ 7, Abs. 2(b))

Stand: Juni 2017