1

Application
for a
Leibniz - DAAD Research Fellowship 2014
Name
Nationality
Chosen
Leibniz Institute
Special Programme „Helmholtz-DAAD-Fellowships“ for Doctoral and Postdoctoral Studies – Application Form – Page 3

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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
  1. Secondary School Education

Duration and location / from / to / in
Type of final exam(certificate title)
Date of award
  1. Higher Education and Academic Degrees

Academic Degree / Major Subject / University/ Town / Country / Duration / Result (%, A-D) / Date
of result
Bachelor
Master
Ph.D.
Other degree
Expected degrees within the following months / Degree Title / Date
(dd/mm/yyyy)
  1. Language Skills

Language / Years of learning / Very good / Good / Fair / Poor
English
German
  1. Previous visits abroad for study / research / work

Country / Town / Institution / Goal / From / To
Germany
  1. Practical / professional work experience

Country / Town / Institution / Goal / From / To
  1. Previous Scholarships

Country / Organisation / Host Institution / Goal / From / To
Germany / DAAD
  1. Envisaged Academic / Professional Career
  1. Social Engagement / Extracurricular Activities
  1. Other Information / Remarks
  1. 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):

  • Abstract of the doctoral/PhD thesis (max. 3 pages);
  • List of publications if any;
  • Complete curriculum vitae;
  • Two letters of recommendation by scientists of the applicant’s own choice (the letters must be included in sealed envelopes or sent by the referees directly to the DAAD in Bonn by the closing date for applications);
  • Copies of academic degree certificates as well as certified translations in English or German;
  • Recent photograph, attached to the application form;
  • Proof of English language skills (e.g. TOEFL: 550/213/80; IELTS: 6.0) not older than five years;
  • Description of the research project (3 pages);
  • Detailed work plan and schedule (1 page).

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.

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Leibniz-DAAD-Research Fellowship / Application Form / Page 1