Application form for international women scientists 2018/19
Dear applicant,
Please fill out the form on your computer and e-mail it to us ().
Thank you!
1.Personal Information
Name
Address
Date and place of birth
Telephone (landline)
Telephone (mobile)
Do you have children?No/ Yes (number of children and year(s) of birth
What are your personal interests/hobbies?
2.Education
Undergraduate study
University
Discipline
Topic of final thesis
Degree (name, year and final grade)
Master’s
University
Discipline
Topic of final thesis
Degree (name, year and final grade)
Vocational Training
Area, year of completion
Languages
German:
English:
Doctoral studies(for doctoral applicants)
Faculty/Department, research group
Type of doctoral studies
Type of funding
Start of doctoral studies
Current phase of study
(Working) title of dissertation
Supervisor
(Planned) date of completion
Postdoctoral studies(for postdoctoral applicants)
title of dissertation, date of completion
Faculty/Department, Research group
Employed/ funded as…
At Bielefeld University since (month/year)
Research interest
Current phase of study
3.Professional development
What do you like about doing research/ being a scientist?
What are your future professional prospects?
What are challenges with regard to your professional development?
4.About the mentoring programme
Previous experience
Have you ever taken part in a mentoring programme?
No
Yes, in (year) I was a mentee / mentor in the programme
Participation in movement
Which aspects of the movement mentoring programme motivated your application?
What is your main concern/ which goals do you pursue by participating in movement?
Which topics would you like to discuss in an exchange with the other mentees?
Which topics would you like to discuss with a mentor?
What needs to happen during the course of the programme so that you will feel it was worth taking part in movement?
At the beginning of the programme, peer groups will lookfor several mentors together to attend their meetings.Is there already a particular person you would like to invite as a mentor?
No/ yes, , namely
One final question:How did you find out about movement?
5.Declaration
Participation in the movement mentoring programme is a valuable opportunity for which you are expected to do the following:
-Participate in programme events and trainings
-Take an active role in shaping the peer group process
-Participate in the evaluation and documentation of the programme
-Keep the programme up to date on any changes in your personal situation that are relevant for the programme (e.g. starting a job, change of contact data, difficulties in the peer mentoring process)
I agree to fulfil these obligations and I have enough time to do so.
movement may use my answers and store my personal data and use them for the project.Data will not be passed on to any third parties.
I confirm that I am a member of Bielefeld University and thus fulfil the prerequisites of the programme
I confirm that the above information is accurate to the best of my knowledge
(place, date, name)
Further remarks:
We’re looking forward to your application!