Proposed Or Planned Future Career

Please attach a a recent photograph

Application for the Carl & Emily Fuchs Foundation Doctoral Scholarship

Biographical Data

Surname Identity Number

First Names Most Recent University Attended

Date of Birth Student Number

Home Language Place of Birth

Nationality Title (please tick) Dr Mr Ms

Contact Details

Home Address Telephone Number

Postal Code Cellphone Number

Postal Address E-mail Address for Correspondence

Postal Code Fax Number

Academic Qualifications

Current Academic Qualifications University/Institution Date Degree(s)/Diploma(s) Name of Graduation

If you are in the process of completing a degree at present, please provide details and anticipated date of completion

Occupation since Graduating/Work Experience

Name of Employer(s) Position Held Commencement and Termination Dates Family Background

Parents – please provide names, age and occupation of parents

Spouse (if applicable)

Other dependents (eg children)

Economic Position

Please describe your economic position

Sources of Income

Who pays or has paid for your academic studies in the past?

Applying the Benefits of the Scholarship in South Africa

Are you willing to enter into an agreement, committing yourself to applying the benefits of your research project/doctoral studies in South Africa for a period equal to the tenure of the scholarship? (Tick appropriate box) Yes No

Proposed Study

University Proposed Doctoral Degree Field of Study

Have you applied to or been accepted by a university? (Please tick appropriate box) Accepted Applied Please also enclose a copy of the acceptance letter, if applicable.

Other Scholarship/Bursary Applications or Awards

Please provide details of any other applications for bursaries or scholarships and/or any anticipated funding or remuneration from any sources

Bursary, Scholarship, Loan Name of Award or Remuneration Value per Annum Applied for or Already Awarded Previous Major Scholarships – please provide details of any major scholarships either presently held or received in the past

Academic Publications and Conference Papers

Please provide a list of any academic publications (if relevant), along with the name of the journal/conference and the date published

Non-academic/Extra-mural Interests

Please indicate any other interests, activities or hobbies apart from your academic interests

Proposed Research Study/Doctoral Programme

Please attach an outline of your proposed research project, including the field of specialization/content of the doctoral programme, summarized in no longer than 5 typed pages

Application and Benefits

How do you see your particular area of specialization/research project contributing to the benefit of South Africa?

Proposed or Planned Future Career

Please indicate your planning relevant to a potential or proposed future career Special Notes

(1) Please arrange for an official academic record of courses completed at any university in the past to be send to: Fuchs Foundation Scholarships, The Carl & Emily Fuchs Foundation, P O Box 1910, Halfway House, 1685. (2) Also arrange for the letter of acceptance into the doctoral programme (if relevant) to be submitted to the address above. (3) Kindly also arrange for three persons acquainted with your academic work and personal qualities to submit confidential references/recommendations in support of this application to the address above. One referee should be the Head of the University Department in which you completed your major, honours, masters or equivalent. (4) Do remember to attach your proposed research project outline to this application.

NB: It will Not be Possible for The Carl & Emily Fuchs Foundation Scholarship Selection Committee to Consider Incomplete Applications

I hereby certify that all the above information is accurate and complete and note that it is my responsibility to submit a complete application and arrange for referees’ reports and any academic records to be submitted to the Carl & Emily Fuchs Foundation.

Signature of Applicant ______Date ______