Berlin
Program
for Advanced German & European Studies
Application
| Page 1 of 5
APPLICANT PROFILE
1.
Please use only Adobe Reader to fill out this form.
Name
First
○ Male
Middle
○ Female
2.
Last
Address
Current
Permanent (if different)
Street
Additional
City
State, ZIP
Country
Phone
E-mail
3.
Eligibility
○ U.S.
○ Canada
○ Citizen
○ Permanent Resident
○ Long-term Resident
(if your main residence was North America before you entered the
Ph.D. program, e. g. if you have received previous academic degrees
(B.A. or M.A.) or worked in North America)
If your application is successful, you will be asked to submit a document of proof.
4.
University/Field of Study
Home University
Department
Discipline
Country/Countries or
Region/Regions of Study
5.
Award Sought
○ Postdoctoral
Date you have received or will receive your Ph.D.:
Please attach your dissertation abstract to this application.
○ Dissertation
Month / Year
Date you will be advanced to or have been advanced to candidacy:
Month / Year
Date you expect to graduate:
Month / Year
Berlin
Program
for Advanced German & European Studies
Application
| Page 2 of 5
PROJECT PROPOSAL INFORMATION
6.
Title & Description
Please give a concise description of your dissertation research or postdoctoral research project.
7.
IRB Approval
If your project requires IRB approval, where are you in the IRB approval process?
○ Approval expected by:
○ Approval received:
○ No IRB approval needed
8.
Length of Stay in Berlin
○ 10 months
9.
Commencement Date
Month /Year
Please select the desired duration of your stay in Berlin.
○ 11 months
○ 12 months
Please select a fellowship commencement date.
○ October 1st (winter semester)
○ April 1st of the following year (summer semester)
10.
Research Travel
Please state location and duration of your desired research travel outside of Berlin.
11.
Affiliations
Please state affiliations with academic institions relevant to your research project.
Berlin
Program
for Advanced German & European Studies
Application
COURSE REPORT
| Page 3 of 5
For all questions on this page: Attach additional files, if necessary
12.
Higher Education
Please list (in reverse chronological order) the schools attended above high school level.
Include the name of the institution, degree date, (rec’d/expected), period of attendance and
fields of study (major/minor).
13.
Course Report
For applicants of dissertation fellowship only.
Please list graduate courses (in reverse chronological order) that are pertinent to your proposed research, including those in which you
are currently enrolled. Provide details about year, institution, discipline, course title, instructor and grade. Explain markings other than
1-100 or A,B,C,D,F. Please attach additional files if necessary.
14.
Publications
Please list any articles, books, or other research you have completed, including M.A. thesis.
Do not submit copies.
Berlin
Program
for Advanced German & European Studies
Application
| Page 4 of 5
EMPLOYMENT, TRAVEL & LANGUAGES
15.
Employment
Institution/Organization
16.
Dates
List previous travel to or residence in any country other than the US or Canada
(include military service).
DatesPurpose
Languages
List languages you speak, read or write, indicating level of fluency, and duration/location of study.
Language/Fluency
18.
Position/Nature of Work
Travel
Place
17.
List (in reverse chronological order) positions you have held since secondary school.
Language Competency
Language
Duration of Study
Location/ Institution
List person(s) submitting language evaluation(s) on your behalf.
Name of Evaluator
Institution
Berlin
Program
for Advanced German & European Studies
Application
| Page 5 of 5
FELLOWSHIPS & ADVISORS
19.
Awards
Please list all previous and current awards and professional honors you have received,
including those from your own university.
20.
References
List three persons (including your principal faculty advisor, listed first)
who are writing references on your behalf.
Referee
21.
Previous Application
○ I have not applied before.
○ I have applied before:
22.
Other Applications
Institution / Department
E-mail
If you have applied to the Berlin Program before, please specify when.
Year(s)
Please list other sources of funding to which you are applying.