Application
for a
Leibniz - DAAD Research Fellowship 2015
Name
Nationality
Chosen
Leibniz Institute
Leibniz-DAAD-Research Fellowship
Application Form
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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
Email
Street
Post code, town
County/state
Country
Fax
Phone
3. Secondary School Education
Duration and location
from
to
in
Type of final exam (certificate title)
Date of award
Leibniz-DAAD-Research Fellowship
Application Form
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4.
Higher Education and Academic Degrees
Academic
Degree
Bachelor
Major Subject
University/ Town
Country
Duration
Result
(%, A-D)
Date
of result
Master
Ph.D.
Other
degree
Expected degrees
within the following
months
Degree
Title
Date
(dd/mm/yyyy)
5. Language Skills
Language
Years of learning
Very good
Good
Fair
Poor
Goal
From
To
Institution
Goal
From
To
Host Institution
Goal
From
To
English
German
6. Previous visits abroad for study / research / work
Country
Germany
Town
Institution
7. Practical / professional work experience
Country
Town
8. Previous Scholarships
Country
Germany
Organisation
DAAD
Leibniz-DAAD-Research Fellowship
Application Form
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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):
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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.
Leibniz-DAAD-Research Fellowship
Application Form
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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
Leibniz-DAAD-Research Fellowship
Signature
Application Form
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