RTC/ICIDR FELLOWSHIP APPLICATION FORM

Personal Data (PRINT ONLY):

Name	First Name	Middle Name (in full)		Last Name

Email
Present Position
Institutional Affiliation
Mailing Address
Telephone	Office		Home	Mobile

Date of Birth	(dd/mm/yyyy)
Place of Birth

Fellowship Information:

For which Research Fellowship are you applying:

Title of proposed research project:

Abstract:
In the space below give a brief statement of your proposal (100 words).

Proposal Description:

On separate pages and in a statement of under 1500 words, please describe in detail the nature of your proposal, how it relates to your scholarly background, the debates you would like to contribute to, and the work you plan to pursue and what methodology you propose. Also, indicate the facilities you plan to use and to what extent you have investigated the availability of relevant sources. Applicants should take note of the fact that the whole application, including the proposal, is submitted to RTC/ICIDR research fellowship review committee for review, in order to obtain official approval.

Letters of Recommendation:

Each applicant is required to arrange for two letters of recommendation to be received by RTC/ICIDR research fellowship review committee before the April 10th, 2006 deadline. All letters will remain confidential. Kindly list below the names, titles, and addresses of the persons from whom you are requesting such letters and who are qualified to attest to your academic standing, your ability to successfully complete your proposed project, and your competence in the languages necessary to your research.

List Name, address, phone number and email of two references:
Name:
Address:
Phone #:	Email:
Name:
Address:
Phone #:	Email:

Educational History:

Pre Master: Master candidates must have successfully completed their qualification exams before the starting date of the requested fellowship; please indicate below when you passed or expect to take the qualification exams.

Pre Master courses	Passed:
	Date: (mm/yyyy)

Colleges or Universities attended (list the most recent first):

High School	Name:		City:		Graduation Date:
Undergraduate College		Name:		City:
Department:
Course(s) of Study:
Dates Attended:		Degree Awarded:		Year:

Publications (Use separate sheet if necessary):

Foreign Language Ability and Proficiency

Please list below the languages in which you are proficient and rank your ability in each category: Excellent, Good, Fair, and Poor.

Name of Language	Speaking	Reading	Writing

Employment History

Begin with present position; use separate sheet if necessary.

1- Position:
Faculty, Research Institute:		Department:
University:
2- Position:
Faculty, Research Institute:		Department:
University:
3- Position:
Faculty, Research Institute:		Department:
University:
Are you currently registered for a Degree:	M.Sc.		Ph.D.	M.D.

By submitting this form I verify that all the information provided by me in this application form is correct to the best of my knowledge.

This application form must be received by RTC/ICIDR research fellowship review committee ON OR BEFORE APRIL 10^th, 2006. FAXED APPLICATIONS ARE NOT ACCEPTED.

Checklist of application materials required after first selection:

	One original and two (2) copies of the fellowship application including the project description and application.
	Two letters of recommendation (+ language proficiency letter if applicable).
	Pre-doctoral applicants: undergraduate and graduate transcripts.

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