Fellowship Application INSTRUCTIONS The Applicant should fill out Part I. The applicant s Home Institute Supervisor should fill out Part II. - Please reply clearly and concisely to each question - Type or write in black ink - When 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: ICTP/IAEA STEP Program The Abdus Salam International Centre for Theoretical Physics C/O Office of External Activities Strada Costiera, 11 34151 Trieste, Italy Telephone no. +39 040 22 40 322 Telefax no. +39 040 22 40 443 e-mail: calligar@ictp.it
Fellowship Application (Part I) (The Applicant should complete the following) 1. Personal Data: Gender: M / F (circle one) Family Name: Given Name: Middle/Maiden Name: Mailing Address (Office): Inst. Name: Are you currently a Ph.D. student at this institute? Street: Date of birth: Place of birth: Nationality: Passport No.: Date of issue: Place of issue: Valid until: Telephone (office): P.O. Box: Post Code: Telephone (home): Town/City: Region/District: Country: Airport/town nearest to residence: 2. Education (commencing with secondary school) Fax: e-mail: Web Page: Emergency Phone no.: 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
Fellowship Application (Part I) (The Applicant should complete the following) 4. Fellowship Objectives: Describe in detail below the research project or training programme to be supported by this fellowship (Please note that the area of research must be of relevance to the list of sub fields as in the announcement of this programme. Please attach separate sheets if necessary): General Area of Research/Training: Specific Areas of Research/Training: 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 (one page minimum): Provide a time outline of the proposal including specific objectives to be achieved and dates:
Fellowship Application (Part I) (The Applicant should complete the following) 5. Please list all previous participation in ICTP or IAEA activities: Attachments (strongly recommended) - List of publications and current Curriculum Vitae - A certificate of English proficiency - 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 documentation to support your application, including suggestions for co-supervisor/host Institution(s). 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 UN LANGUAGES: LANGUAGE: READING: [ ] GOOD [ ] AVERAGE [ ] POOR WRITING : [ ] GOOD [ ] AVERAGE [ ] POOR SPEAKING: [ ] GOOD [ ] AVERAGE [ ] POOR
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 refrain from engaging in any political or other activities, which would reflect unfavourably on the host laboratory or the international status of the centre. I understand that any breach of this undertaking may result in the termination of the arrangements relating to my visit in the framework of this programme. I understand that UNESCO, the International Atomic Energy Agency, the International Centre for Theoretical Physics, the host laboratory and the host country shall not be held liable for compensation in the event of my death, injury or illness during my travel to and from the host country or during my stay there. I am aware that I will have to pay all expenses relating to my passport, visa, medical examination and other incidental expenses; Before signing please be sure that all the questions have been answered SIGNATURE OF THE APPLICANT DATE Certification of the Home Institute Supervisor: I am cognisant of the principles and rules pertaining to ICTP/IAEA supported training awards and nominate the applicant for a STEP 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, including nuclear installations or institutions where ionizing radiation is used. I certify that the information provided by the applicant is correct and I agree on the work proposed. SIGNATURE OF THE SUPERVISOR DATE
Fellowship Application (Part II) (The applicant s home institute supervisor should complete the following) 1. Supervisor Personal Data: Sex: M / F (circle one) Family Name: Given Name: Middle/Maiden Name: Mailing Address (Office): Inst. Name: Street: Date of birth: Place of birth: Nationality: Telephone (office): P.O. Box: Post Code: Telephone (home): Town/City: Region/District: Country: Fax: e-mail: 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 in the applicable fields of training as specified in the programme announcement. 4. In addition to ICTP, please provide below specific information regarding potential European collaborators and institutes with expertise relevant to the Fellow s research project: 5. Justification of applicant's research plan:
6. Supporting Documentation Please provide a list of recent publications on your ongoing research work 7. PhD thesis supervised Please provide the titles of the PhD theses already supervised in the last 5 years 8. Participation in ICTP Programmes Are you an ICTP Associate? Are you aware of the ICTP programmes which may enable a visit of yours to the ICTP? Please list all your previous participations in ICTP Programmes For successful applications a scientist, working on subjects relevant to the PhD thesis of the student, will be identified in the Trieste Institutions, to tutor the student and thus to act as a co-supervisor during his/her stay in Trieste. The thesis work will be coordinated between the home supervisor and the co-supervisor. It is thus important for the supervisor and the cosupervisor to get in touch before the fellowship begins. The STEP office is responsible for providing the relevant data (e-mail, ph.nrs, addresses) to enable this contact. Joint meetings of the supervisor with the co-supervisor and the student are highly desirable. The STEP fellowship is meant to begin after the first contact between supervisor and cosupervisor has taken place.