Leibniz - DAAD Research Fellowship 2015

Application for a Leibniz - DAAD Research Fellowship 2015

Nationality

Chosen Leibniz Institute

Leibniz-DAAD-Research Fellowship Application Form Page 1 2

1. 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

2. Contact Data

Street

Post code, town

County/state

Country

3. Secondary School Education

Duration and location fro to in m

Type of final exam (certificate title)

Date of award

4. Higher Education and Academic Degrees

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

Master

Other degree

Expected degrees Date within the following Degree (dd/mm/yyyy months Title )

5. 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

8. 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

12. 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.

Place Date Signature

Leibniz-DAAD-Research Fellowship Application Form Page 5