If you are completing this application by hand, please use black ink. Other colors do not photocopy well!

Please check the name of the institution through which you are applying to the Project:

Uniwersytet im Adama Mickiewicza w Poznaniu

Landeszentrale für politische Bildung (Heidelberg)

Akademia Pedagogiczna im. Komisji Edukacji Narodowej w Krakowie

  1. Personal Information

Name, Birth Date
& Citizenship /

Last name

Given name(s)
Date of birth
Place of birth
List all countries of which you are a citizen
Semester
Address /

Street

City
Country
Postal Code
Telephone
E-mail
Cellular phone

PermanentAddress

/

Street

City
Country
Postal Code
Telephone
E-mail

II.Academic Background

Home
University / University name
Degree(s) sought
Projected date of completion
Major/minor field(s) of study
What field(s) do you
intend to teach?
At which level(s) do you
intend to teach?

If you have already completed a university-level, degree please indicate:

the name of the degree (e.g. Master’s or Magister or Staatsexamen)and field (e.g. history, Polish philology):

the institution from which you received the degree and when:

Please summarize all your post-secondary studies, including the university you currently attend:

Institution / Dates (From-To) / Field(s) of study / Degree Received

Please indicate the nature and extent of your previous living, studying, or traveling abroad.

Please list the names of two persons who will be writing letters in support of your application (at least one must teach at your home university):

1.

2.

III.Statement of Purpose

Please attach a summary, in English, of your reasons for wanting to participate in the Project. What do you hope for yourself from your participating? How do you see participating in the Project making an impact on your future career as a teacher? What can you contribute to the group and the Project as a whole? You should indicate your background in Holocaust, multicultural, and/or anti-racist education (including extra-curricular activities). Your summary should be a maximum of two pages in length and should bear the heading “Statement of Purpose.”

IV.Curriculum Vitae

Please attach a one-page curriculum vitae (resumé), in English, to this application. Include relevant information on where you have lived, your education, employment, volunteer work, international experience, hobbies and interests, relevant skills and qualifications, and prizes, scholarships and awards.

V.Instructions to Applicants

Please submit the original and two copies of the following documents to Dr. Aleksandra Boroń (students from Poznań/Gniezno), Dr. Piotr Trojański (students from Kraków), or Mr. Peter Trummer at the Landeszentrale für politische Bildung Baden-Württemrberg (students from Germany). They will inform you of their deadlines.

  1. This signed application form with photograph attached (please do not photocopy the photographs; attach originals to the application form)
  2. Your “Statement of Purpose”
  3. Your curriculum vitae
  4. Official transcript(s) or certified lists of courses taken from all post-secondary institutions attended (these may be in English or French)
  5. Letters of support (in English or French) from two persons, at least one of whom must teach at your home university

If you have questions about the Project or this application form, please feel free to contact either Professor Michael Brown at The Centre for Jewish Studies () or Professor Mark Webber at The Canadian Centre for German and European Studies ().

I hereby certify that the information given on this application form and in my other supporting documents is accurate to the best of my knowledge. I understand that the submission of incomplete, false, or misleading information renders me ineligible to participate in the project.

Date: ______Signature: ______

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