a | United Nations Educational, Scientific and Cultural Organization 1, place de Fontony, 75252 Pars 07 SP teen: (23.1) 45681000 rout Pas teeta UNESCO: (53.1) 45.86.0829 Instructions: The application form should be submitted by the appropriate govern- ‘mental body and each part should APPLICATION FOR FELLOWSHIP. accurately, The application should bbe submitted in three copies. The Information requested should. be ether typed or writen in ink in block. capitals. Where additional space is needed, a separate sheet should be Used and attached in three copies. be answered completely and A. Official presentation ‘The Government of the candidature of In the field of. for a duration of. under Programme and/or Project ‘The undersigned certifies that Its the Government's intention to have ‘organized a programme of study such that will port the candidate To increase nis Contbution to the development of his country In the future. Ha fellowship is granted, the Government wi (@) provide the necessary assistance to the fellow for departure to Begin the study programme; PRESENTED FOR: Ca ‘ovareneia it Date presents herewitn for a UNESCO fellowship to begin (©) assist the flow In meeting personal and tansy responsibities uring the period of his felowship by mainainng, necessary, Continuation of the whole or part of his present remuneration (6) acitate employment of the fellow in the assignment mentioned In this application upon competion of the fellowship, 18 is cerifed that information contained herein is complete and ‘curate, By: i ao pbs Signature B. Background data concerning the candidate Family name (surname) Fist and middle names Nationality ‘Occupation Permanent address Telephone: ema oase attach photo hore (Optional Malling address. ‘Tolophone, GW aitferent from above). E-mail Date of bith Country and place of bith Sex day month year ‘Marital status | Full name of spouse ‘Number and age of children | Name and address of person to natily in case of ‘oo228 95) accidentEduca Name, place and country Yeats atlended Degrees, diplomas. Date of educational establishments com To Indeate main subjects obtained Secondary, technical, ete Post-secondary, university, or equivalent IMPORTANT: This application is not considered complete unless accompanied by certied copies of diplomas received and academic tran- Sserpts of courses followed and grades or marks obtained Other studies Mention any other studies undertaken, including training/refresher courses Fellowships and scholarships ‘Which of the above studies were undertaken with a fellowship or scholarship? Mention the sponsor of the grant Visits abroad List any significant visits abroad not mentioned above Publications and research List any significant publications (cluding publisher and date of publication) and any major research projects undertaken Languages Mother tongue Understand te other languages “ enc “ee “ Not Not Not Not easly JM] easty [Me | rtsenty ] gti | rasty | ae The UNESCO certiicate of language knowledge should be completed and attached to this application References List tie persons, not related to the candidate, who can provide Information on his/her qualifications. These persons should normally be teachers or supervisors acquainted with the candidate's previous academic work Fall name ile and addressPrevious professional activities Exact thle of post Annual salary Name and ttle of supervisor Name and tie of UNESCO expert counterpart (rary Dates of sence Employer = = Responsibilities Present position ‘Name and address of employer ‘current duties Years of sevice From To C. Trail \g objectives Nature of studies Indicate eld of study and particular areas of specialization ‘Should the sludies be directed toward oblaining a diploma, degree ‘or qualification oF should the studies have mainly a practical or applied orientation? Is the purchase of special equipment required? [Should the programme include preparation of a thesis or other piece of research? Place(s) of study lundertaken 4 2 andlor (others In order of preference, suggest counties of study and Tst below them any preferences Tor Insitutions where the studies could be 2 andlor For what reasons are the institutions (sted abave being proposed? iention any previous contact with these intitalions and attach confirmation of admission, avaiable IMPORTANT: Any further contact for the fellowship programme should be made only through UNESCO