HITEC Fellowship – Application Form

Given Name/First Name Surname/Last Name

Master’s Degree or equivalent

In:
Exact Title:
From (University or other institution/city/country):

Research Interest/Motivation

It is mandatory that you indicate your research interests referring to a section of the IEK or a partner
university, to a research topic and/or a research group. Please describe what skills and scientific
experience enable you to successfully work in this field as a PhD student (you might refer to the field
Scientific Experience).

1
Scientific Experience

Please outline briefly your research projects, completed or ongoing. Describe your experimental
background and list the methods you have used in your research.

Personal Data

Given Name/First Name Surname/Last Name Gender

Male Female
Date of Birth Place of Birth
---- ------------- -----

Nationality Country of Permanent Residence

Marital Status No. of Children

------- ----

2
Mailing Address, where you may be contacted at any time:
c/o
Street

Zip Code/Town/State/Country

Home Address:
Street
Zip Code/Town/State/Country

E-mail Address
Tel.-No.

Educational Data

Bachelor Degree

Exact Title

University or other Degree awarding institution (Name, city, country)

From Until Degree awarded on

---- ------------- ----- ---- ------------- ----- ---- ------------- -----

Main Subject/Major Subsidiary Subject/Minor

Results/Marks

Master’s Degree

Exact Title

University or other Degree awarding institution (Name, city, country)

From Until
---- ------------- ----- ---- ------------- -----

3
Degree awarded on Award expected
---- ------------- ----- ------------- -----

Main Subject/Major Subsidiary Subject/Minor

Thesis Title

Results/Marks

Further Degrees

Exact Title

University or other Degree awarding institution (Name, city, country)

From Until
---- ------------- ----- ---- ------------- -----

Degree awarded on Award expected

---- ------------- ----- ------------- -----

Main Subject/Major Subsidiary Subject/Minor

Thesis Title:

Results/Marks

4
Degrees held (summary)

Awarded on Exact Degree Title Subject/Major Marks

(day/month/year)

Further Skills

Publications (if applicable)

Journal Articles

Conference Contributions

Academic Honours, Awards, Fellowships

5
Professional Data

Employer

Address

From Until
---- ------------- ----- ---- ------------- -----
Responsibility/Task

Employer

Address

From Until
---- ------------- ----- ---- ------------- -----

Responsibility/Task

Employer

Address

From Until
---- ------------- ----- ---- ------------- -----

Responsibility/Task

6
References

Name Title

Institution

Address

E-Mail

Tel.-No.

Name Title

Institution

Address

E-Mail

Tel.-No.

Command of the English language

Native Speaker Fluent Good Basic

___________________________ __________________________
Location, date Signature