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ICTPIAEA Sandwich Fellowship Application

By Eddie Lopez,2014-03-18 17:02
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ICTPIAEA Sandwich Fellowship ApplicationICTPIA

    WIO-RISE Graduate Training Component Fellowship Application

Carnegie-IAS Regional Initiative in Science and Education (RISE

    WESTERN INDIAN OCEAN REGIONAL INITIATIVE IN MARINE SCIENCE AND EDUCATION (WIO RISE) NETWORK

    INSTRUCTIONS

    The Applicant should fill out Part I. The applicant’s Institution Supervisor should fill out Part II.

    - Please reply clearly and concisely to each question - Type or write in black ink

    - If more space is required, please attach additional pages - A recent photograph of the applicant should be attached. If the form is transmitted via

    email, please mail the photograph separately to the below address

Kindly note all documents must be presented in English and will not be returned to

    the candidate.

The completed application along with supporting documentation should be submitted to:

    DIRECTOR

    Institute of Marine Sciences

    University of Dar es Salaam

    Mizingani Rd

    P.O. Box 668 ZANZIBAR

    TANZANIA

    Telephone no. +255 24 2232128

    Telefax no. +255 24 2233050

    e-mail: director@ims.udsm.ac.tz

    WIO-RISE Graduate Training Component Fellowship Application

     (Part I)

    (The Applicant should complete the following)

1. Personal Data:

    Sex: M / F (circle one) Date of birth:

    Family Name: Place of birth:

    Given Name: Nationality:

    Middle/Maiden Name: Passport No.:

    Date of issue: Mailing Address (Office):

    Inst. Name: Place of issue:

     Valid until:

    Street: Telephone (office): P.O. Box: Post Code: Telephone (home): Town/City: Fax:

    Region/District: e-mail:

    Country: Web Page:

     Emergency Phone no.:

    2. Education (commencing with diploma)

    Years attended Name and place of institution Field of study Diploma or

    degree from to

    3. Recent Employment Record

    Years of Service Name and place of Employer Position Title Type of Work from to

    WIO-RISE Graduate Training Component Fellowship Application

    4. Fellowship Objectives: Describe in detail below the research project to be supported by this fellowship (Please note that the area of research must be of relevance to the research

    questions in the WIO - Region. Please attach separate sheets if necessary):

General Area of Research/Training:

Specific Areas of Research/Training:

Proposed Ph.D. Project Title:

    Previous Work done relevant to this Project by you or your Ph.D. Supervisor (provide publications where possible):

Please provide a summary of the research/training activity to be supported by this fellowship:

Provide a time outline of the proposal including specific objectives to be achieved and dates:

    WIO-RISE Graduate Training Component Fellowship Application

    Attachments

- Publications and current Curriculum Vitae

    - A recent medical certificate of good health

    - A certificate from your Home Institution Supervisor stating his/her recommendation

    for your participation in this program.

    - Any other optional documentation to support your application

    Languages

WHAT IS YOUR MOTHER TONGUE?

    PLEASE INDICATE BELOW YOUR PROFICIENCY IN THE ENGLISH LANGUAGE:

READING: [ ] GOOD [ ] AVERAGE [ ] POOR

    WRITING : [ ] GOOD [ ] AVERAGE [ ] POOR

    SPEAKING: [ ] GOOD [ ] AVERAGE [ ] POOR

    PLEASE INDICATE BELOW YOUR PROFICIENCY IN OTHER LANGUAGES:

LANGUAGE: __________________

READING: [ ] GOOD [ ] AVERAGE [ ] POOR

    WRITING : [ ] GOOD [ ] AVERAGE [ ] POOR

    SPEAKING: [ ] GOOD [ ] AVERAGE [ ] POOR

    WIO-RISE Graduate Training Component Fellowship Application

    Certification

Certification of the Applicant:

    I certify that the statements made by me above are true and complete. If accepted, I undertake to complete my studies within the provided time frame and to refrain from any other activity, which would reflect unfavourably on the host institution and the project. I understand that any breach of this undertaking may result in the termination of the fellowship.

Before signing please be sure that all the questions have been answered

    SIGNATURE OF THE APPLICANT________________________DATE______________

Certification of the Applicant’s Institution Supervisor:

    I nominate the applicant for a WIO-RISE Graduate Training Component Fellowship. Noting the responses given by the applicant to the questions above, I give assurances that:

    To my knowledge, all information supplied by the applicant is complete and correct.

    No facts are known to me regarding the reliability and character of the applicant which would obstruct giving him/her access to research facilities of the University of ………………….and other collaborators.

    My organisation will support and release him/her during the entire fellowship period to undertake the study

I certify that the information provided by the applicant is correct and I agree on the work proposed.

SIGNATURE OF THE SUPERVISOR______________________DATE______________

    WIO-RISE Graduate Training Component Fellowship Application

    (Part II)

     (The applicant’s home institution supervisor should complete the following)

     1. Supervisor Personal Data:

    Sex: M / F (circle one) Date of birth:

    Family Name: Place of birth:

    Given Name: Nationality:

    Middle/Maiden Name:

    Mailing Address (Office):

    Inst. Name:

    Street: Telephone (office):

    P.O. Box: Post Code: Telephone (home):

    Town/City: Fax:

    Region/District: e-mail:

    Country: Web Page:

    2. Employment

    Years of Service Name and place of Employer Position Title Type of Work from To

     3. Explain clearly and fully how the experience gained by the fellow’s participation

    will directly benefit scientific research at your institute/organisation in the applicable fields of training as specified in the programme announcement.

     4. Justification of applicant's research plan:

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