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Please fill in this form fully and accurately and cross out any non-applicable sections!

APPLICATIONfor a Doctorate Scholarship from RWTH Aachen University

Receipt Stamp

In accordance with the Guidelines for the Support of Young Researchers at RWTH Aachen University (RFwN), I apply for graduate support in the form of a:

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Basic Scholarship First Application Follow-up Application

3 Last Name:

4 First Name:

Matriculation No.:

Date of Birth:

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5a

Information on the research project:

Topic of the dissertation:

Dr.rer.nat. Dr.rer.medic.

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7

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9

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Dr.phil. Degree Pursued: Dr.-Ing.

Doctorate Advisor / Supervisor:

2nd Dissertation Reviewer:

Faculty / Department:

Start of dissertation (Date):

Expected completion date of the dissertation:

Scholarship period applied for From to = months

Academic Career:

12 Number of completed semesters in the subject of the dissertation (total number

of semesters in the Bachelor´s and Master´s courses of study):

13 Total number of completed semesters at university (including semesters studied

at other universities):

14 Completed preliminary and final examinations at university:

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University

Date of Exam

Exam Result

Dr.rer.pol.

Name of examination (e.g. Diplom-

Vorprüfung, Magister, Master)

Subject

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Personal Information:

15 Address:

16 Phone a) home: b) office (University):

17 E-Mail:

___________________________________________________________________________________________________________________________

18 Banking Account: Financial Institution IBAN BIC

19 Gender : male

female

20 Nationality: German (other nationality)

21 Legal Relationshipto the Applicant

Information on children (please enclose copies of the birth certificates):

Last Name, First Name Date of Birth

1.

2.

22 I apply for a child benefit in accordance with § 10 RFwN

no yes

23 Does your spouse receive a scholarship according to the RFwN or does she/he currently apply for such a scholarship? Or does she/he apply for a scholarship of a similar character?

no yes (please name the scholarship-providing institution and the scholarship period)

24 Did you already receive a scholarship according to the Graduate Promotion Act ("Graduiertenförderungsgesetz")?

no j yes between and

from institution:

25 Did you apply for any other graduate scholarship from another institution?

no yes institution

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26 Employment at the University

Past and current paid employment as a research assistant / student assistant or similar (in accordance with § 44

University Act/Law Governing Higher Education and § 46 University Act/Law Governing Higher Education, respectively)

as between and = months

between and = months

between and = months

27 Employment outside of the University

Past and current paid employment as a research assistant / student assistant or similar (in accordance

with § 44 University Act/Law Governing Higher Education)

and = months

between and = months

between and = months

between and = months

between and = months

Please enclose evidence of your employment as research assistant / student assistant.

28 Current employment - weekly working hours more than 10 h per week

up to 10 h per week

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Reduction down to a max. of 10 h has been agreed on

Civil Service Probationary Period ("Vorbereitungsdienst")

as between and = months

between and = months

between and = months

between and = months

between and = months

30 Do you expect that the completion of the dissertation will incur any additional costs, which might require an application for additional funding?

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32

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Material costs no yes in the amount of approx. €

Travel costs no yes €

Stay Abroad no yes

in the amount of approx.

in the amount of approx. €

}Please explain the nature of and background to these costs in more detail on a separate sheet.

(Travel Destination) (Duration of Research Stay) (Date of Departure)

34 How did you fund your doctoral studies so far? Did you receive any scholarship from public funds?

as bet ween

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Explanations:

- RWTH Certificate of Enrollment as a student with the sole objective of completing a doctorate

Comfirmation by the administrator:

The nationality of the applicant (line 20) was

verified using the- If required for the approval of additional benefits: civil status certificates, such as birth certificates of children

personal ID no.: - copy of the University Entrance Qualification

- Copies of academic transcripts- Work Schedule, timeline (time frame for dissertation project),

(Signature) - Completed supervisor questionnaires from both the primary and secondary supervisors (supervisor and reviewer)

- CV with an emphasis on studies/academic career - Confirmation of the faculty that the applicant is admitted

I declare that the details given on this form and on the enclosed documents are accurate and complete.

I have taken note of the provisions of the Guidelines for the Support of Young Researchers (RFwN). If my application for a

doctorate scholarship is approved, I obligate myself to

- dedicate myself to preparing and completing my doctoral studies and not to engage in any external activity/work that is not compatible with the scholarship (§ 9 RFwN)

- disclose all information to RWTH Aachen University that are relevant to the scholarship, its amount, and its possible extension (e.g. a change in my personal or financial situation, commencement of a part-time job)

a) if I decide to interrupt or terminate my doctoral studies;

b) of the completion of my doctorate;

- to inform RWTH Aachen University of the results of my doctoral project, to submit a final report, and, in case that I am not able to complete my doctorate within the scholarship period, to submit annual reports on the status of my doctoral project, for at least three years after the scholarship period or until my dissertation is submitted.

Date Signature

This application includes:

- to immediately inform RWTH Aachen University

dissertation abstract

to doctoral studies