Fillable Printable Application for Fellowship Under UNESCO Fellowships Programme

Application for Fellowship Under UNESCO Fellowships Programme

The Government of..............................................................................................................................................................................................................................

presents herewith

the candidature of................................................................................................................................................................................................................ for a UNESCO fellowship

in the ﬁeld of

..................................................................................................................................................................................................................................................................................................

for a duration of ....................................................................................................................... to begin.........................................................................................................................................

under Programme and/or Project

United Nations Educational, Scientiﬁc and Cultural Organization

7, place de Fontenoy, 75352 Paris 07 SP

telephone: (33.1) 45.68.10.00

telex: 204461 Paris

270602 Paris

telefax UNESCO: (33.1) 45.66.94.29

APPLICATION FOR FELLOWSHIP

under the

UNESCO FELLOWSHIPS PROGRAMME

The application form should be

submitted by the appropriate govern-

mental body and each part should

be answered completely and

accurately. The application should

be submitted in three copies.The

information requested should be

either typed or written in ink in block

capitals. Where additional space is

needed, a separate sheet should be

used and attached in three copies.

Instructions:

A. Ofﬁcial presentation

The undersigned certiﬁes that it is the Government’s intention to have

organized a programme of study such that will permit the candidate

to increase his contribution to the development of his country in the

future.

If a fellowship is granted, the Government will:

(a) provide the necessary assistance to the fellow for departure to

begin the study programme;

(b) assist the fellow in meeting personal and family responsibilities

during the period of his fellowship by maintaining, if necessary,

continuation of the whole or part of his present remuneration;

in this application upon completion of the fellowship.

It is certiﬁed that information contained herein is complete and

accurate.

PRESENTED FOR:

(seal)

............................................................................................................................................

Governmental unit

.........................................................................................................................................................

Date

BY:

.........................................................................................................................................................

Name and title of responsible ofﬁcer

.........................................................................................................................................................

Signature

B. Background data concerning the candidate

Family name (surname) First and middle names

.................................................................................................. .............................................................................................

Nationality

........................................................

Occupation

........................................................

Permanent address Telephone.......................................................

................................................................................................................................................................. E-mail...................................................................

Mailing address........................................................................................................................... Telephone........................................................

(if different

from above)

.................................................................................................................................... E-mail...................................................................

Date of birth

day month year

................. .............................. .................

Country and place of birth

.......................................................................................................................

Sex

..................................

Please attach photo here

(Optional)

Marital status

........................................

Full name of spouse

..................................................................

Number and age of children

............................................................................

Name and address of person to notify in case of

accident

...................................................................................................................

IMP/0023A (x.95)

Education

Name, place and country

of educational establishments

Secondary, technical, etc.

.......................................................................................................................

.................

...................

Post-secondary, university, or equivalent

.......................................................................................................................

Degrees, diplomas:

Indicate main subjects

Years attended

Date

obtained

from to

IMPORTANT: This application is not considered complete unless accompanied by certiﬁed copies of diplomas received and academic tran-

scripts of courses followed and grades or marks obtained

Other studies

Mention any other studies undertaken, including training/refresher courses

Fellowships and scholarships

Which of the above studies were undertaken with a fellowship or scholarship? Mention the sponsor of the grant

Visits abroad

List any signiﬁcant visits abroad not mentioned above

Publications and research

List any signiﬁcant publications (including publisher and date of publication) and any major research projects undertaken

Languages

Mother tongue:

References

List three persons, not related to the candidate, who can provide information on his/her qualiﬁcations. These persons should normally be

teachers or supervisors acquainted with the candidate’s previous academic work

Other languages

.....................................................................

...........................

Read

Easily

Not

easily

Easily

Not

easily

Fluently

Not

ﬂuently

Easily

Not

easily

Understand

(spoken)

Speak Write

The UNESCO certiﬁcate of language knowledge should be completed and attached to this application

Full name

.................................................................................................................

Title and address

Employer Responsibilities

Current duties

Dates of service

From To

Previous professional activities

Present position

Name and address of employer

...................................................................................................................................................................

Years of service From To

................................................... .................................................

Exact title of post

...................................................................................................................................................................

Annual salary

...................................................................................................................................................................

Name and title of supervisor

...................................................................................................................................................................

Name and title of UNESCO expert counterpart

(if any)

...................................................................................................................................................................

C. Training objectives

Nature of studies

Indicate ﬁeld of study and particular areas of specialization Should the studies be directed toward obtaining a diploma, degree

or qualiﬁcation or should the studies have mainly a practical or

applied orientation?

Should the programme include preparation of a thesis or other piece of research?

Is the purchase of special equipment required?

Place(s) of study

Mention any previous contact with these institutions and attach conﬁrmation of admission, if available

IMPORTANT: Any further contact for the fellowship programme should be made only through UNESCO

For what reasons are the institutions listed above being proposed?

In order of preference, suggest countries of study and list below them any preferences for institutions where the studies could be

undertaken

1. 2. 3.

and/or and/or

(others)

Details of proposed studies

(If additional space is needed, separate sheets should be attached)

Give precise details of studies to be undertaken

Give realistic budget estimates for the fellowship requested (return travel, monthly allowance, tuition fees, etc.)

Expected results and future assignment

Candidate’s statement

Indicate how it is envisaged to make the best use of the results achieved and specify what position will be taken up at the

end of the fellowship with a description of future responsibilities

If UNESCO grants me a fellowship I agree to take up after my period of study the position to be assigned to me as described

above. I certify the information I have provided is complete and accurate

Candidate’s signature