Vorm Vir Hamburg-Uitruil

1. Complete the application form by entering the requested data into all form fields.

1. Email the completed formwith attachments (as indicated in the checklist at the end of the application form) to

1. The closing date for applications is: 27 November2014

I have read and understand the application procedure and will submit the completed application form in addition to the requested documents as per checklist.

2.1Title:

2.2Initials:

2.3 Surname:

2.4Department:

2.5Post level:

2.6Date of appointment at Stellenbosch University (dd/mm/yyyy):

2.7Tel(Work) :Tel (Home):

2.8Accompanied by family?Yes___No___

Please note: Accommodation provided by KU Leuven allows for residence of only one person that can at most be used for a married couple with children under the age of 6 years.

Details, if accompanied:

3.1Title and short research plan or description of programme at host institution:

3.2Name of host/co-worker:

3.3Department/Institute where you will be working:

3.4Address:

3.5To what extent is your host / co-worker involved in the project?

3.6Duration of visit:

3.7Period (supply exact dates where possible):

3.8Significance (especially for the department / faculty) of the proposed visit:

3.9Why is it important for the project to be undertaken in Leuven?

1. Resident Representative

The Resident Representative is a new initiative that forms part of the Preferential Partnership between Stellenbosch University and KU Leuven.

The Resident Representative will be expected to spend at least 4 months at KU Leuven. Accommodation will be covered for the full period by KU Leuven.

Please indicate if you also wish to apply for this position

Yes

No

Please provide a short motivation for your interest in this role

5.1Letter of invitation:

Yes No

5.2Research record for the past 5 years (Supply any of the following information) (not applicable for applications by Administrative staff)

a)Full-length articles in accredited JOURNALS

b)Articles as part of PROCEEDINGS at national and international congresses

c)OTHER professional publications

d)PAPERS read at national and international professional conferences

e)PROMOTER/CO-PROMOTER for completed and current M theses and D dissertations

5.3Endorsements:

Confidential Recommendation from Chair of the Department or Director of Institute (with emphasis on the Significance of the research/study programme for the homeinstitution)

Confidential Recommendation from the Dean or Chair of Governing Committee of the Institute / Centre or Vice-Rector (with emphasis on the significance of the research/study programme for the home institution)

Signature of applicant:

Date (dd/mm/yyyy):