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    Application Form NAM Research Fellowship

    Uploaded by

    myat soe

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Application Form NAM Research Fellowship

    Uploaded by

    myat soe
    4 views2 pages

    Original Title

    Application_Form_NAM_Research_Fellowship

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    4 views2 pages

    Application Form NAM Research Fellowship

    Uploaded by

    myat soe

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    CENTRE FOR SCIENCE AND TECHNOLOGY OF THE

    NON-ALIGNED AND OTHER DEVELOPING COUNTRIES


    (NAM S&T CENTRE)

    NAM S&T CENTRE RESEARCH FELLOWSHIP

    APPLICATION FORM
    (Please TYPE or use BLOCK capitals; No column should be left blank.)

    Affix
    Recent
    SECTION A
    (To be filled in by the Applicant) Photograph

    1. Name (Dr/Mr/Mrs/Ms): ___________________________________________


    (as in Passport)
    2. Designation (Position held) ________________________________________
    3. Nationality:_____________________________________________________
    4. Date of Birth:__________ Place of Birth (City) ___________
    (Country)_______
    5. Passport No. ___________ Place of issue:__________________
    Date of Issue:_______________ Valid up to:__________________________
    6. Full Address (Home): ____________________________________________
    _____________________________________________________________
    Phone:______________ Fax: ______________ E-mail: _________________
    7. Name of the Parent Institution (employer): __________________________
    Full Address (Office):____________________________________________
    ____________________________________________________________
    Phone: _______________Fax:________________ E-mail: _____________
    8. Academic Qualifications:
    Highest Degree: ___________________________
    Year of Award: ____________________________
    University:_______________________________
    Field of Study: ___________________________
    9. Brief Curriculum Vitae, including Professional and Research Experience (to
    be attached on a separate sheet along with a list of publications)
    10. Purpose of the Visit with a Plan of Work (To be attached on a separate
    sheet)
    11. Name of the Host Institution: ______________________________________
    Name / Designation of the Contact Person in the Host Institution:
    ____________________________________________________________
    Full Address of the Host Institution:
    ____________________________________________________________
    ____________________________________________________________
    Phone: _______________Fax:________________ E-mail: _____________
    Please attach Acceptance Letter from the Host Institution

    Signature of applicant: ______________________________


    Date _________________

    Signature of the Head of the


    Parent Institution with seal: ____________________
    Date:_________________

    SECTION -B

    ENDORSEMENT BY THE FOCAL POINT OF THE NAM S&T CENTRE


    (For name / address of the Focal Points please visit Centre’s website
    www.namstct.org)

    (Signature)
    Name (in full): ...........................................................................

    Designation: .......................…....................................................

    Date: ....................….......................………….............................

    SEAL
    Check List for the Enclosures to be attached:

    i) Brief Curriculum Vitae (including Professional and Research Experience and a list of publications,
    if any).
    ii) Purpose of the Visit – Plan of Work.
    iii) Acceptance letter from the host agency / institution, indicating financial liability of the host
    agency/institution.

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