8

NEW EUROPE COLLEGE

Mailing Address: Str. Plantelor 21, 023971 Bucharest, Romania

Tel.: (+4) 021 307 99 10, Fax: (+4) 021 327 07 74

Contact person: Constantin Ardeleanu, E-mail:

Relevant files to this program can be viewed/downloaded from: www.nec.ro

THE PONTICA MAGNA FELLOWSHIP PROGRAM

(October 1, 2017 – July 31, 2018)

APPLICATION FORM

Attach a recent photo

LAST NAME: ______

FIRST NAME: ______

CITIZENSHIP(S): ______

GENDER: MALE ___ FEMALE ___

DATE AND PLACE OF BIRTH:

Day / Month / Year / Locality / Country

MAILING ADRESS:

Zip Code______Locality Country

Tel.: ______Fax: ______E-mail:

(Include country and local area codes)

FIELD OF STUDY:

YEAR OF ENROLMENT IN A Ph.D. PROGRAM, IF APPLICABLE:

TITLE OF YOUR PROJECT FOR THE FELLOWSHIP:

PLEASE WRITE A SUMMARY OF YOUR PROJECT FOR THE FELLOWSHIP (of max. 1,000 characters, spaces included)

PREFERRED DURATION AND TIME OF FELLOWSHIP:

a. October through February ___ b. March through July ___ c. October through July ___

AFFILIATION(S): (State all present affiliations and positions):

Institution 1:

Position:

Mailing address:

Tel.: ______Fax: ______E-mail:

(Include country and local area codes)

Institution 2:

Position:

Mailing address:

Tel.: ______Fax: ______E-mail:

(Include country and local area codes)

Institution 3:

Position:

Mailing address:

Tel.: ______Fax: ______E-mail:

(Include country and local area codes)

Institution 4:

Position:

Mailing address:

Tel.: ______Fax: ______E-mail:

(Include country and local area codes)

EDUCATION (List educational institutions attended in reverse chronological order, including any in which you may be presently enrolled.)

INSTITUTION AND LOCATION / MAJOR FIELD OF STUDY / DATES
(Month and Year)
From To / NAME OF DEGREE OR DIPLOMA (in original language and Engl. translation) / DATE RECEIVED/
EXPECTED

TITLE OF Ph.D. THESIS (original title and English/French/German translation) if applicable

(original title):

(title translated into English/French/German):

LIST SCHOLARSHIPS OR FELLOWSHIPS HELD AT PRESENT OR IN THE PAST: (Include source or sponsor, where held, and duration.)

INDICATE ANY ACADEMIC HONORS OR PRIZES WHICH YOU HAVE RECEIVED, WITH TITLES AND DATES:

TEACHING EXPERIENCE (Including any teaching positions you have held or currently hold):

RESEARCH (Including any research you have completed, or in which you are currently involved)

Or prominent achievements in your field

LIST PROFESSIONAL SOCIETIES, FRATERNITIES OR OTHER ORGANIZATIONS IN WHICH YOU NOW HOLD A MEMBERSHIP OR IN WHICH YOU HAVE BEEN ACTIVE IN THE PAST:

PLEASE INDICATE IF YOU ARE PLANNING TO APPLY OR HAVE APPLIED FOR A FELLOWSHIP, SCHOLARSHIP, OR OTHER GRANT OR LOAN FROM ANOTHER ORGANIZATION, GOVERNMENT OR EDUCATIONAL INSTITUTION FOR THE PERIOD 2017-2018:

LIST THE INSTITUTION(S) YOU INTEND TO VISIT DURING YOUR ONE-MONTH RESEARCH UNDER THE PONTICA MAGNA PROGRAM (optional):

KNOWLEDGE OF LANGUAGES: (Rate yourself Excellent, Good or Fair. Include all languages in which you have some competency and which may be relevant to your research project)

LANGUAGE / READING / WRITING / SPEAKING

I confirm that, to the best of my knowledge, the information provided in my application is accurate and complete (please check with an “x” the square below).


CURRICULUM VITAE


LIST OF PUBLICATIONS or other types of achievements (If necessary, give also English/French/German translations.) Media professionals and writers are asked to include a sample of their previous work. Artists should present a portfolio.


WRITE A CLEAR PROJECT OUTLINING YOUR INTENDED RESEARCH UNDER THE PONTICA MAGNA PROGRAM. The project should mention the state of research in the field, and include bibliographic references. In the case of media professionals, writers, and artists, please outline a project in your area of activity. (Do not exceed 10 000 characters with spaces.)