<p> Please attach a a recent photograph</p><p>Application for the Carl & Emily Fuchs Foundation Doctoral Scholarship</p><p>Biographical Data</p><p>Surname Identity Number</p><p>First Names Most Recent University Attended</p><p>Date of Birth Student Number</p><p>Home Language Place of Birth</p><p>Nationality Title (please tick) Dr Mr Ms</p><p>Contact Details</p><p>Home Address Telephone Number</p><p>Postal Code Cellphone Number</p><p>Postal Address E-mail Address for Correspondence</p><p>Postal Code Fax Number</p><p>Academic Qualifications</p><p>Current Academic Qualifications University/Institution Date Degree(s)/Diploma(s) Name of Graduation</p><p>If you are in the process of completing a degree at present, please provide details and anticipated date of completion</p><p>Occupation since Graduating/Work Experience</p><p>Name of Employer(s) Position Held Commencement and Termination Dates Family Background </p><p>Parents – please provide names, age and occupation of parents</p><p>Spouse (if applicable)</p><p>Other dependents (eg children) </p><p>Economic Position </p><p>Please describe your economic position</p><p>Sources of Income</p><p>Who pays or has paid for your academic studies in the past?</p><p>Applying the Benefits of the Scholarship in South Africa</p><p>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 </p><p>Proposed Study</p><p>University Proposed Doctoral Degree Field of Study</p><p>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.</p><p>Other Scholarship/Bursary Applications or Awards</p><p>Please provide details of any other applications for bursaries or scholarships and/or any anticipated funding or remuneration from any sources </p><p>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</p><p>Academic Publications and Conference Papers</p><p>Please provide a list of any academic publications (if relevant), along with the name of the journal/conference and the date published</p><p>Non-academic/Extra-mural Interests</p><p>Please indicate any other interests, activities or hobbies apart from your academic interests</p><p>Proposed Research Study/Doctoral Programme</p><p>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</p><p>Application and Benefits</p><p>How do you see your particular area of specialization/research project contributing to the benefit of South Africa?</p><p>Proposed or Planned Future Career</p><p>Please indicate your planning relevant to a potential or proposed future career Special Notes</p><p>(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.</p><p>NB: It will Not be Possible for The Carl & Emily Fuchs Foundation Scholarship Selection Committee to Consider Incomplete Applications</p><p>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.</p><p>Signature of Applicant ______Date ______</p>