MIT-TECHNION POST-DOCTORAL FELLOWSHIPS - 2012/2013
Application Form
The MIT-Technion post-doc program main objective is to train Technion
graduates of PhD programs to become future faculty at the Technion.
INSTRUCTIONS:
A list of publications must be included in the CV
A) PERSONAL INFORMATION
1. Name (both in English and Hebrew)
ID number
2. Permanent address in Israel
3. Current address (if different)
4. Phone numbers
home:
work:
mobile:
5. E-mail address
6. Date of birth
7. Place of birth
8. Date of arrival in Israel
9. Marital Status (if married, include
name of spouse)
10. Children and ages
11. Which family members will
accompany you abroad?
12. Contact person in Israel while you are Name:
ATTACH
PHOTO
HERE
abroad
13. Present appointment and place of
employment
14. Proficiency in foreign languages
15. Interests and hobbies
B) ACADEMIC CAREER
16. Academic discipline
17. Academic studies and university
degrees
If degrees were conferred with
honours, please indicate.
18. Title of PhD dissertation
19. Submission of PhD thesis
(month/year); If not yet submitted,
please provide anticipated date
20. Academic awards and distinctions
21. Periods of academic study and
research outside Israel; please
provide date, location and field of
study
C) PLANNED STUDY AND RESEARCH AT
MIT
22. List your potential host(s) at MIT. If
you have an invitation letter, please
attach it
23. When do you plan to begin your
studies at MIT?
24. Period of proposed research or study
25. When do you expect to return to
Israel?
26. With that in mind, to what Technion
department(s) do you intend to apply
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Contact details:
(please list them according to your
priority preference and add some
explanation as to why do you think
these departments are likely to
consider your candidacy after you
complete your Post-doc training)
D) FINANCE
27. Do you expect to have any other
financial resources beside the MIT
fellowship?
28. Please provide a summary of your dissertation (up to one page).
29. Please provide a summary of your present research (if different from your dissertation).
30. Please describe your planned research activities for the academic year 2012/2013.
31. Explain, in some detail, the reasons for your choice of MIT and the academic supervisor, and
the connection, if any, with your present and planned future work (up to 130 words).
32. Please describe in one paragraph (10-12 lines) what you hope to have achieved at the
conclusion of your post-doctoral studies. Please explain in what specific ways you expect to
benefit professionally from the time spent abroad.
I agree to provide any further information which may deem necessary to evaluate my
candidacy.
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Date
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Signature