how to complete the form - africa centers · web viewinter-university council for east africa p o...
TRANSCRIPT
Inter-University Council for East Africa
P O Box 7110, Kampala, Uganda
Tel: +256 +256 772-340-544
E-Mail: [email protected]
Website: www.iucea.org
MASTERS FELLOWSHIP APPLICATION FORM
Supporting Young Talented Female Scientists to Become Future Leaders
PLEASE ATTACH A RECENT PASSPORT SIZE PHOTOGRAPH
(3x4)
Reference No:
(for official use)
Received on:
(for official use)
How to complete the form
1.Please complete the application form in type, or write in CAPITAL letters and BLACK ink.
2.Please quote your e-mail address, as all correspondence will be via e-mail.
3.Please make a copy of the form for yourself before sending it to IUCEA/RFU.
4.Fill in all the sections, otherwise delays will occur when processing your application.
5.The closing date for fellowship applications to be received is June 22 2018. Fellowship applications received after the closing date will not be considered.
A. Personal details (as they appear on your passport)
Last/family name:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
First name:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Other names:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Address:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Phone: - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
E-mail: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Gender:
- - - - - - - - - - - - -
Date of birth
(day/month/year)
/ /
Passport No: - - - - - - - - - - -- - - - - - - - - - -
Place of Issue:- - - - - - - - - - -- - - - - - - - - - -
Date of Issue: - - - - - - - - - - -- - - - - - - - - - -
Date of Expiry:- - - - - - - - - - -- - - - - - - - - - -
Nationality of Birth
- - - - - - - - - - - - - - - -
Current Nationality
- - - - - - -- - - - - - - - - -
B. Programme of study
Title of degree programme admitted to:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Admission number:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Name and address of university:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Name of African Center of Excellence:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
C. Education history and qualifications
Please list qualifications and grades which you have already obtained starting with the most recent:
Dates attended
School, university or college / country
Qualification name (e.g. high school certificate, BSc in…)
Grade/class
Date obtained
D. Work experience
Please describe any work experience which is relevant to your proposed study programme, starting with your most recent position:
Employment Dates
Name of employer/organisation
Job title and responsibilities
E. Publications, Conferences, awards
List articles you have published or presented in conferences, and award for outstanding achievement, if any.
F. Personal statement
These fellowships are awarded on the basis of academic ability, future potential and relevance, and the selectors will pay special attention to the information you provide here. Please tell us about your academic achievements and ambitions. In particular, please explain why you have chosen your particular field of study and its importance to the region’s development:
G. References
Name and Position
Contact Address
H. Declaration
I hereby declare that I have understood and comply with the eligibility criteria, and I make a true statement about my details.
Signature (or type your name):
Date:
I. Checklist
i) Completed application form
ii) Recent passport-size photograph
iii) Summarized CV with names and contacts of two referees
iv) Certified copies of academic certificates and transcripts
v) Certified copies of passport or national identity card indicating citizenship
vi) Copy of admission letter from one of the host universities (please refer to the attached table on Countries, ACEs and Universities)
vii) Two (2) reference letters with contact addresses
In addition, applicants must scan and produce electronic copies of all the above documents (converted to PDF format) and send by e-mail to [email protected] with a copy to [email protected] to be received by June 22 2018. And July 13, 2018 for Zambian nationals only.
1