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Licentiate and Degree Application Personal details Fill out the address and contact information thoroughly. Use clear block letters and no abbreviations. Unclear or missing information can cause the degree certificate to be sent to the wrong address or make it difficult to get in contact with you if we have any questions about your application.

Swedish national identity number/ registration number Given name and surname c/o Postal address

Postal code City/Town

Country Phone number

Email

I do not speak Swedish and would like to be contacted in English if necessary

Degree of Mark the degree you apply for. Ekonomie licentiat (Licentiate of Philosophy) licentiat (Degree of Licentiat) Farmacie licentiat (Degree of Licentiate) Odontologie licentiat (Degree of Licentiate) Filosofie licentiat (Licentiate of Philosophy) Teknologie licentiat (Licentiate of Technology) Juris licentiat (Licentiate of ) Teologie licentiat () Konstnärlig licentiat (Licentiate of Philosophy in Fine Arts)

Degree of doctor Mark the degree you apply for. Ekonomie doktor () Medicine doktor (Doctor of Philosophy) Farmacie doktor (Doctor of Philosophy) Odontologie doktor (Doctor of Philosophy) Filosofie doktor (Doctor of Philosophy) Teknologie doktor (Doctor of Technology) Juris doktor (Doctor of Laws) Teologie doktor () Konstnärlig doktor (Doctor of Philosophy in Fine Arts)

Section of Degrees, phone number: +4631-786 1050, email: [email protected] Send your application to: University of Gotheburg, Section of Degrees, Box 100, SE-405 30 Gothenburg,

Field of study

Signature I have made sure that all courses that I want to include in the degree are finished and registered in the study

registration programme, Ladok.

Date Signature

Section of Degrees, phone number: +4631-786 1050, email: [email protected] Send your application to: University of Gotheburg, Section of Degrees, Box 100, SE-405 30 Gothenburg, SWEDEN