Name and address of person to be notified in case of emergency

Application

For a

Leibniz - DAAD Research Fellowship 2015

Name

Nationality

Chosen Leibniz Institute

Personal Data

Surname
	Please use the name exactly as stated in your passport, underline main name

Academic title

First name(s)

Date of birth

Place of birth

Country of birth

Country of residence

Gender

male

female

Marital status

married

single

Number of children

Present occupation

Present employer

Contact Data

Email

Street

Post code, town

County/state

Country

Fax

Phone

Secondary School Education

Duration and location

from

to

in

Type of final exam(certificate title)

Date of award

Higher Education and Academic Degrees

Academic Degree	Major Subject	University/ Town	Country	Duration	Result (%, A-D)	Date of result
Bachelor
Master
Ph.D.
Other degree

Expected degrees within the following months

Degree Title

Date (dd/mm/yyyy)

Language Skills

Language	Years of learning	Very good	Good	Fair	Poor
English
German

6. Previous visits abroad for study / research / work

Country	Town	Institution	Goal	From	To
Germany

7. Practical / professional work experience

Country	Town	Institution	Goal	From	To

Previous Scholarships

Country	Organisation	Host Institution	Goal	From	To
Germany	DAAD

9. Envisaged Academic / Professional Career

10. Social Engagement / Extracurricular Activities

11. Other Information / Remarks

Name and address of person to be notified in case of emergency

E-mail
Street

Postcode

Town/Suburb

State/County/Province

Country

Phone/ FAX

The completed application form must be accompanied by the following documents (in English):

· curriculum vitae;

· list of publications (if any);

· description of the research project (max. 3 pages);

· detailed work plan and schedule (max. 1 page);

· abstract of the doctoral thesis (max. 3 pages);

· two letters of recommendation, which should be written by scholars of the applicant’s own choice and must be enclosed in sealed envelopes or sent by the referees directly to the DAAD head office in Bonn by the closing date for applications;

· copies of all academic degree certificates and transcripts of records with certified translations into English or German;

· English language certificate (e.g. TOEFL, IELTS) or confirmation of the English language skills by a university teacher of the applicant´s own choice.

The application and accompanying documents will remain with the DAAD. Personal data will be stored in the DAAD’s computer files only to the extent necessary for administration of applications and fellowships and in compliance with the “Federal Data Protections Act“. Data will be provided to the respective Leibniz Institute which will be included in the decision making process.

Applicant‘s declaration:

I certify that the information in this application is accurate to the best of my knowledge. Furthermore I agree to inform the DAAD immediately of changes and amendments. I have taken note of the information provided regarding this application as well as the notice about the storage of personal data. I accept responsibility for my completed application. I agree that this application and accompanying documents shall remain with the DAAD.

I agree that the DAAD will forward the documents and the personal details to the Leibniz Association and its relevant institutions, which take the final decision. Neither the DAAD, nor the Leibniz Association nor the Leibniz Institutions will pass on the details to third parties.

Дата добавления: 2015-10-29