2012-2013 Application Form
Application Deadline: September 30, 2011 / Applications should be sent by your university’s Foreign Affairs Office to the e-mail address below.
Email:
Phone: 617-495-3369 Fax: 617-495-7798
Web:
Application Form- Please type or write in black ink
APPLICANT INFORMATION
Family name: / Given name:
漢字: / Age: / Gender (M/F):
Place of birth / City: / Province: / Country:
Date of birth (Month/Day/Year):
Citizenship (nation from which passport is obtained):
Present title as faculty member:
Anticipated date of Ph.D. completion:
University: / Department:
Office address:
Home telephone: / Office telephone:
E-mail: / Fax:
Best mailing address:
EDUCATION
Colleges/Universities Attended / Principal Subject / Dates of Study / Degree/Year Awarded
RECOMMENDATION LETTERS
Please list the names and contact information of the individuals from whom you are requesting letters of recommendation. Threeletters (in English) are required, one of which must be from your adviser or the person most familiar with your scholarly work. Please send the three letters together with your application form (preferably as Microsoft Word documents).
Name / Address / Email / Phone/Fax
FACULTY
List 1-2 faculty member(s) at Harvard University and/or any other major university in the Boston area with whom you wish to consult during the stay of the fellowship. It is not necessary to contact faculty during the application process.
Name: / Institution:
Department and Field:
List one to two of the above faculty member’s publications (with detailed citation information) that are highly relevant to your research.
Name: / Institution:
Department and Field:
List one to two of the above faculty member’s publications (with detailed citation information) that are highly relevant to your research:
HONORS
List previous fellowships, scholarships, grants and other honors:
FUNDING/PREVIOUS APPLICATIONS
Are you applying for funding from any other organizations? (Yes/No) :
Have you ever applied for a Harvard-Yenching Scholarship Before? (Yes/No): / If so, when? :
Have you ever been issued a Harvard ID before? (Yes/No):
DISSERTATION
Title of Dissertation:
Name and Academic Position of your Ph.D. Adviser:
EMPLOYMENT
List all positions held, academic or other, in chronological order (with dates). Include the date from which you have held your present faculty position:
PUBLICATIONS
Please list titles in the original language as well as English. Attach a separate bibliography
if space here is insufficient.
FOREIGN TRAVEL
If you have visited or lived in any countries other than the one in which you are now employed, please list places, dates and purposes.
LANGUAGES
Indicate your knowledge of the languages listed below, and any others. If one is your own language, write native. Elsewhere, indicate slightly, fairly well or fluently.
ENGLISH / Speak: / Read:
CHINESE / Speak: / Read:
JAPANESE / Speak: / Read:
KOREAN / Speak: / Read:
THAI / Speak: / Read:
VIETNAMESE / Speak: / Read:
OTHER / Speak: / Read:
OTHER / Speak: / Read:
OTHER / Speak: / Read:
DISSERTATION DESCRIPTION
What is the subject of your Ph.D. dissertation? Please provide a 2-3 page description, indicating how far you have progressed in writing it. Explain how a Visiting Fellowship at Harvard University would contribute to your dissertation. Insert the extra pages into this application form as necessary.
Note to applicants: University transcripts must be sent together with this application.