EAST ASIA INSTITUTE

Fellows Program
on Peace, Governance, and
Development in East Asia

2015-2016

APPLICATION FORM


EAST ASIA INSTITUTE

Knowledge-Net for a Better World

EAI Fellows Program 2015-2016

Application Cover Sheet(1/4)

Please type or print neatly in English:

Name:
(Last Name) / (First) / (Middle)
Citizenship(s): / Gender:
Date of Birth (mm/dd/yyyy):
Proposed Title of the Project:
Status of Applicant:
□ Tenured / □ Tenure-Track / □ Non-Tenured / □ Other (please give details):
Preferred Dates of Visit:(check more than one box ifyour schedule is flexible)
□ March - June 2016 / □ September –December 2016 / □ Other (please give dates):
Preferred Institutions for Visit:(check two or more boxes)
□ East Asia Institute, Seoul
□ Fudan University, Shanghai
□ Keio University, Tokyo / □ Peking University, Beijing
□ National Taiwan University, Taipei
Project Summary:In the space below, please summarize your project (100-150 words in English)

Applicant Data Form(2/4)

Name:
(Last Name) / (First) / (Middle)
Title: / Department:
Institution:
Email Address:
Preferred Mailing Address:□ Home□ Work
Work Address
Mailing Address:
City: / State: / Zip code:
Office Phone: (include country and area codes)
Fax: (include country and area codes)
Home Address
Mailing Address:
City: / State: / Zip code:
Home Phone: (include country and area codes)

Language Ability(3/4)

Name:
Chinese:
1) Conversation
2) Reading
3) Writing / (Please specify the type of Chinese):
□Basic □Intermediate □ Advanced □Fluent
□Basic □Intermediate □ Advanced □Fluent
□Basic □Intermediate □ Advanced □Fluent
Japanese:
1) Conversation
2) Reading
3) Writing / □Basic □Intermediate □ Advanced □Fluent
□Basic □Intermediate □ Advanced □Fluent
□Basic □Intermediate □ Advanced □Fluent
Korean:
1) Conversation
2) Reading
3) Writing / □Basic □Intermediate □ Advanced □Fluent
□Basic □Intermediate □ Advanced □Fluent
□Basic □Intermediate □ Advanced □Fluent
Major Publications (List up to four)
References (4/4)
First Referee
Name:
Institutional Affiliation:
E-mail Address:
Second Referee
Name:
Institutional Affiliation:
E-mail Address:
Please help us to evaluate our outreach efforts. How did you learn about the EAI Fellows Program?
□ Advertisement (please specify) / □ Internet(please specify)
□ Friend (please specify) / □ Other(please specify)
Please list any other fellowship programs to which you are also currently applying:

I certify that the statements made in this application are true and complete to the best of my knowledge.

Signature of ApplicantDate: Month / Day / Year

Application Check-List

To be sent by the applicant:

______1.Application Form(4 pages)

______2.ProjectProposal (5-10 pages)

______3.Curriculum Vitae

To be sent by the referees:

______4.Two letters of recommendation, sent directly to the EAI by the individual referees

Mailing Instructions

Please send us the application documents 1-3 by airmail ore-mail attachment to the address below.For email application, the file format should be PDF.Letters of recommendation must be sent directly to the EAI by individual referees.

Please note: The deadline for receiving all application materials is July 10, 2015.

For further information, please contact:

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