B. Personal Information Concerning the Student

IPCC Secretariat C/O World Meteorological Organization 7bis Avenue de la Paix C.P. 2300 CH- 1211 Geneva 2, Switzerland APPLICATION FOR SCHOLARSHIP AWARD Phone : +41-22-730-8208/54/84 Fax : +41-22-730-8025/13 Email: [email protected]

Deadline for submission: Candidates must also provide: 15 February 2015  Research proposal  Copy of passport/ID (if available) To be submitted online via portal at:  Provisional budget  Photo http://www.ipcc.ch/apps/scholarship/applicant/  Admissions offer for PhD studies/ certificate of enrolment

A. Brief presentation

Application submitted by:

Family name First Name(s) Nationality/ies

...... ……………………………….

for an IPCC Scholarship in the field of: Underlying science of climate change Socio-economic modelling related to climate change Climate Change and water Climate change and the oceans

Duration of studies:

Start Date …………………………. End Date …………………………

Name of Institution (University/Department, country): ...... Intended Supervisor: Title, Name:…………………………………………………………………………………………… Supervisor’s Email/Tel. ……………………………………………………………………………………………..

B. Personal information concerning the student

Permanent address: Telephone: E-mail:

Mailing address (if different from above):

Telephone: E-mail:

Date of birth Country and place of birth Sex day month year

...... Male Female Education

Years attended Name, place and country Degrees, diplomas: Date of educational establishments Indicate main subjects obtained from to

Secondary, technical, etc.

......

...... Post-secondary, university, or equivalent

......

Other studies Mention any other studies undertaken, including training/refresher courses

Fellowships and scholarships Describe any scholarships or other grants or awards you have obtained for your past or present studies

Visits abroad List any signiﬁcant visits abroad not mentioned above

Publications and research List any signiﬁcant publications (including publisher and date of publication) and any major research projects undertaken

Languages Mother tongue:

Reading ability Oral Comprehension Speaking ability Writing ability Other languages Easily Not easily Easily Not easily Fluent Not fluent Easily Not easily

......

...... Any certiﬁcates of language knowledge should be attached to this application

References List three persons, not related to the candidate, who can provide information on his/her qualiﬁcations. These persons should normally be teachers or supervisors acquainted with the candidate’s previous academic work

Full Name Title and Address Previous professional activities (complete if applicable)

Employer Dates of service Responsibilities From To

Present position (complete if applicable)

Name and address of employer Current duties ...... Years of service From To

...... Exact title of post ...... Annual salary

...... Name and title of supervisor ...... C. Objectives Details of proposed studies for 2015-17 Give precise details of studies to be undertaken PhD studies in:

Title of research topic:

Taught courses or specific training to be undertaken, if any:

Approximate Itemized Budget Total expected budget …………………. (please provide breakdown on excel sheet provided)

Expected results

Candidate’s statement If IPCC grants me a scholarship, I agree to apply what I have learned for the benefit of my home country, assuming an appropriate assignment at my country’s government or other institution is offered. If I do not return to my home country for at least 3 years of service, I am prepared to refund the scholarship amount awarded. I certify the information I have provided is complete and accurate

______Date Candidate’s signature