UNIVERSIDAD NACIONAL AUTÓNOMA DE MÉXICO
POSTDOCTORAL FELLOWSHIPS PROGRAM
APPLICATION FORM
LENGTH OF STAY / FROM / FEBRUARYMARCHAPRILMAYJUNEJULYAUGUSTSEPTEMBEROCTOBERNOVEMBERDECEMBERJANUARY / 20132014MONTH / YEAR
TO / JANUARYFEBRUARYMARCHAPRILMAYJUNEJULYAUGUSTSEPTEMBEROCTOBERNOVEMBERDECEMBER / 20142015
MONTH / YEAR
PROPOSING
SCHOOL/FACULTY
THIS APPLICATION CAN BE DOWNLOADED IN WORD FORMAT AND MUST BE SENT TO THE PROPOSING SCHOOL/FACULTY, INCLUDING ALL REQUIRED DOCUMENTS.
For more information send e_mail to:
dgapa@.unam.mx
PERSONAL DETAILS
NAME :LAST NAME FIRST NAME MIDDLE NAME
R.F.C. :
MEXICAN CITIZENS ONLY /C.U.R.P. :
AGE :
MALE FEMALESINGLE MARRIED
NUMBER OF DEPENDENTS:
COMPLETE ADDRESS ( INCLUDE ZIP CODE)
COUNTRY:
TELEPHONE:
FAX:
E-MAIL:
PREVIOUS HIGHER EDUCATION
BACHELOR’S DEGREEMAJOR:
INSTITUTION :
COUNTRY:
DATE AWARDED: JANUARYFEBRUARYMARCHAPRILMAYJUNEJULYAUGUSTSEPTEMBEROCTOBERNOVEMBERDECEMBER 19951996199719981999200020012002200320042005200620072008200920102011
MONTH / YEAR
SPECIALIZATION DIPLOM
FIELD OR SPECIALTY:
INSTITUTION:
COUNTRY:
DATE AWARDED: JANUARYFEBRUARYMARCHAPRILMAYJUNEJULYAUGUSTSEPTEMBEROCTOBERNOVEMBERDECEMBER 199519961997199819992000200120022003200420052006200720072008200920102011
MONTH / YEAR
MASTER’S DEGREE
FIELD OR SPECIALTY:
INSTITUTION:
COUNTRY:
DATE AWARDED : JANUARYFEBRUARYMARCHAPRILMAYJUNEJULYAUGUSTSEPTEMBEROCTOBERNOVEMBERDECEMBER 1999200020012002200320042005200620072008200920102011
MONTH / YEAR
DOCTOR’S DEGREE
FIELD OR SPECIALTY:
INSTITUTION:
COUNTRY:
DATE AWARDED : JANUARYFEBRUARYMARCHAPRILMAYJUNEJULYAUGUSTSEPTEMBEROCTOBERNOVEMBERDECEMBER 200720082009201020112012201320142015
MONTH / YEAR
OTHER DEGREE
DEGREE : BACHELOR SPECIALTY MASTER DOCTOR FIELD OR SPECIALTY:
INSTITUTION:
COUNTRY:
AWARDED / JANUARYFEBRUARYMARCHAPRILMAYJUNEJULYAUGUSTSEPTEMBEROCTOBERNOVEMBERDECEMBER 199819992000200120022003200420052006200720082009201020112012201320142015
DOCUMENT MONTH / YEAR
OTHER DEGREE
DEGREE : BACHELOR SPECIALTY MASTER DOCTOR FIELD OR SPECIALTY:
INSTITUTION:
COUNTRY:
AWARDED / JANUARYFEBRUARYMARCHAPRILMAYJUNEJULYAUGUSTSEPTEMBEROCTOBERNOVEMBERDECEMBER 2000200120022003200420052006200720082009201020112012201320142015
DOCUMENT MONTH / YEAR
OTHER DEGREE
DEGREE : BACHELOR SPECIALTY MASTER DOCTOR FIELD OR SPECIALTY:
INSTITUTION:
COUNTRY:
AWARDED / JANUARYFEBRUARYMARCHAPRILMAYJUNEJULYAUGUSTSEPTEMBEROCTOBERNOVEMBERDECEMBER 2000200120022003200420052006200720082009201020112012201320142015
DOCUMENT MONTH / YEAR
OTHER DEGREE
DEGREE : BACHELOR SPECIALTY MASTER DOCTOR FIELD OR SPECIALTY:
INSTITUTION:
COUNTRY:
AWARDED / JANUARYFEBRUARYMARCHAPRILMAYJUNEJULYAUGUSTSEPTEMBEROCTOBERNOVEMBERDECEMBER 200020012002200320042005200620072008200920102012201320142015
DOCUMENT MONTH / YEAR
CURRENT EMPLOYMENT STATUS
UP TO DATE INFORMATION
INSTITUTION:
APPOINTMENT (S):
CURRENT SALARY:
SUPPORT REQUEST INFORMATION
FIELD OR SPECIALTY OF THE RESEARCH:PHYSICS, MATHEMATICS AND ENGINEERING BIOLOGICAL, CHEMICAL AND HEALTH SCIENCES SOCIAL SCIENCES HUMANITIES AND ARTS
FIELD ACADEMIC DISCIPLINE
TITLE OF PROPOSED RESEARCH:
ABSTRACT OF PROPOSED RESEARCH PROJECT (10,000 CHARACTERS MAXIMUM)
SPOUSE AND/OR CHILDREN DATA
NAME / DATE OR BIRTHOTHER FELLOWSHIP, GRANT OR SCHOLARSHIP
HAVE YOU APPLIED FOR OTHER FUNDING? YES NONAME OF SPONSOR :
AMOUNT (USD) MONTHLY THER
DATE: FROM TO
DAY/MONTH/YEAR DAY/MONTH/YEAR
SUPPORT REQUEST ITEMS :
COMMITMENTS :
RESEARCH SUPERVISOR AT UNAM
NAME :LAST NAME FISRT NAME MIDDLE NAME
R.F.C. :
FIELD OR SPECIALTY :
BIOLOGICAL AND HEALTH SCIENCES SOCIAL SCIENCES PHYSICS, MATHEMATICS AND ENGINEERING HUMANITIES AND ARTS
FIELD ACADEMICAL DISCIPLINA
HIGHEST DEGREE ATTAINED
BACHELOR SPECIALTY MASTER DOCTORFIELD OR SPECIALTY :
ASSIGNED DEPARTMENT :
TELEPHONE :
FAX : E-MAIL:
SIGNATURE OF APPLICANT DATE