INDIA INSTITUTE FELLOWSHIPAPPLICATION FORM

(for incoming fellows from India)

Applications should be typewritten and boxes ticked as appropriate.

Applicant Information

Title: / First Name: / Family Name:
Gender (M/F):
Correspondence Address:
Email address:
Telephone Number:
Scientific Field:
Present appointment and responsibilities (give start date, title and position):
Nationality:
Country of Permanent Residence:

Academic history

Higher education institutions attended and qualifications obtained:
University / Institute / Dates of attendance / Qualifications awarded and class of Honours, etc. / Principal Subject(s) taken
Other information relevant to your academic history:
English Language (please describe your familiarity with written and spoken English, including any IELTS/TOEFL or similar results):

career history

Please give details of employment and/or professional experience (current first):
Date(s)
From To / Nature of work and Position held / Name and address of employer
Title and reference of up to 5 key publications in refereed journals:
Please enclose a full list of publications (with titles) in refereed journals. Please do not send copies of the papers:
PROPOSED RESEARCH
University of Birmingham School/Department in which proposed research is to be conducted:
Name of Academic contact at Birmingham:
Proposed start and end date:
Duration of project:
Please give a brief outline of the proposed research project to be conducted at Birmingham.
How does this research fit in with your present work in India?
How would this Fellowship help your scientific research, teaching and career development?

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.
Signature: / Date:

home university reference

This section is to be completed by the Head of Department of applicant’s Home University/Institute
Name of University:
Department:
Which of the following terms best describe the applicant? (please tick) / Outstanding / Good / Moderate
A researcher who has made contributions which are:
An early career researcher/lecturer whose abilities and promise are:
Which of the following terms best describe the English language ability of the applicant? (please tick) / Good / Average / Fair
I agree to the applicant’s absence from the Institution between and (please tick this box to confirm)

home university declaration and Signature

I certify that my answers are true and complete to the best of my knowledge.
I confirm that the Applicant holds a full-time permanent academic position, or is conducting full-time postdoctoral research in this University
Signature: / Date:
Name in capitals please: / Stamp of University:

university of BIRMINGHAM reference

This section is to be completed by the contact in the Birmingham School willing to accept the Fellow if their application is successful
Name:
Department:
Statement of support from Birmingham academic contact:
Signature: / Date:

WHEN COMPLETED, PLEASE EMAIL APPLICATION FORM TO