United Nations Educational, Scientific and Cultural Organization

APPLICATION FOR FELLOWSHIP

7, place de Fontenoy, 75352 Paris 07 SP
telephone: (33.1) 45.68.10.00 under the
telex: 204461 Paris
270602 Paris UNESCO FELLOWSHIPS PROGRAMME
telefax UNESCO: (33.1) 45.66.94.29

Instructions: The application form should be accurately. The application should capitals. Where additional space is
submitted by the appropriate govern- be submitted in three copies. The needed, a separate sheet should be
mental body and each part should information requested should be used and attached in three copies.
be answered completely and either typed or written in ink in block

A. Official presentation
The Government of .............................................................................................................................................................................................................................. presents herewith
the candidature of................................................................................................................................................................................................................ for a UNESCO fellowship
in the field of ..................................................................................................................................................................................................................................................................................................
for a duration of ....................................................................................................................... to begin.........................................................................................................................................
under Programme and/or Project ................................................................................................................................................................................................................................................

The undersigned certifies that it is the Government’s intention to have (b) assist the fellow in meeting personal and family responsibilities
organized a programme of study such that will permit the candidate during the period of his fellowship by maintaining, if necessary,
to increase his contribution to the development of his country in the continuation of the whole or part of his present remuneration;
future. (c) facilitate employment of the fellow in the assignment mentioned
in this application upon completion of the fellowship.
If a fellowship is granted, the Government will:
(a) provide the necessary assistance to the fellow for departure to It is certified that information contained herein is complete and
begin the study programme; accurate.

PRESENTED FOR: BY:

(seal) ............................................................................................................................................ .........................................................................................................................................................

Governmental unit Name and title of responsible officer

......................................................................................................................................................... .........................................................................................................................................................

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Date Signature

B. Background data concerning the candidate

Family name (surname) First and middle names Nationality Occupation

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Permanent address Telephone.......................................................

................................................................................................................................................................. E-mail...................................................................
Please attach photo here
(Optional)
Mailing address ........................................................................................................................... Telephone........................................................
(if different
from above) .................................................................................................................................... E-mail...................................................................

Date of birth Country and place of birth Sex

day month year
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Marital status Full name of spouse Number and age of children Name and address of person to notify in case of
accident
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IMP/0023A (x.95)
 Education
Years attended
Name, place and country Degrees, diplomas: Date
of educational establishments Indicate main subjects obtained
from to

Secondary, technical, etc.

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Post-secondary, university, or equivalent

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IMPORTANT: This application is not considered complete unless accompanied by certified copies of diplomas received and academic tran-
scripts 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 (including publisher and date of publication) and any major research projects undertaken

Languages
Mother tongue:
Understand
Read Speak Write
(spoken)
Other languages
Not Not Not Not
Easily Easily Fluently Easily
easily easily fluently easily

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The UNESCO certificate of language knowledge should be completed and attached to this application

References
List three 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

Full name Title and address

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 Previous professional activities
Dates of service
Employer Responsibilities
From To

Present position
Name and address of employer Current duties
...................................................................................................................................................................

...................................................................................................................................................................

Years of service From To

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Exact title of post

...................................................................................................................................................................

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Annual salary
...................................................................................................................................................................

Name and title of supervisor

...................................................................................................................................................................

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Name and title of UNESCO expert counterpart

(if any)
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C. Training objectives
Nature of studies
Indicate field of study and particular areas of specialization Should the studies be directed toward obtaining a diploma, degree
or qualification or should the studies have mainly a practical or
applied orientation?

Should the programme include preparation of a thesis or other piece of research?

Is the purchase of special equipment required?

Place(s) of study
In order of preference, suggest countries of study and list below them any preferences for institutions where the studies could be
undertaken

1. 2. 3.
and/or and/or

(others)

For what reasons are the institutions listed above being proposed?

Mention any previous contact with these institutions and attach confirmation of admission, if available

IMPORTANT: Any further contact for the fellowship programme should be made only through UNESCO
 Details of proposed studies
(If additional space is needed, separate sheets should be attached)

Give precise details of studies to be undertaken

Give realistic budget estimates for the fellowship requested (return travel, monthly allowance, tuition fees, etc.)

Expected results and future assignment

Indicate how it is envisaged to make the best use of the results achieved and specify what position will be taken up at the
end of the fellowship with a description of future responsibilities

Candidate’s statement

If UNESCO grants me a fellowship I agree to take up after my period of study the position to be assigned to me as described
above. I certify the information I have provided is complete and accurate

Candidate’s signature