Zukunftskolleg

Zukunftskolleg P.O. Box 216 78457 Konstanz Germany Phone: +49 (0)7531 / 88 - 4897 Fax: +49 (0)7531 / 88 - 4829 zukunftskolleg@uni-konstanz.de www.zukunftskolleg.uni-konstanz.de

Fellowship Application Form 2012 1. Personal details

Academic title: First name: Nationality: Gender: Surname: Date of Birth: female

male

Postal address:

E-mail:

Phone:

2. Academic background
Subject / Discipline: Date Ph.D. awarded: Grade of the Ph.D, if graded: Current employer's name and address (if employed): Current position: Date contract will terminate, if on a temporary contract:

BW-Bank Konstanz, Kontonr. 7 486 501 274 BLZ. 600 501 01 IBAN: DE92 6005 0101 7486 5012 74 BIC: SOLA DE ST Paketanschrift: Universitt Konstanz, Universittsstrae 10, 78464 Konstanz

3. Fellowship program applied for

ZIF-Marie Curie 2 year Postdoctoral Fellowship____________________________________________ Prerequisites: 1. you have obtained a doctoral degree (PhD or equivalent) 2. must not have had your main residence in Germany for more than 12 months during the three years prior to the application deadline
Residence in from until

ZIF-Marie Curie 5 year Research Fellowship______________________________________________ Prerequisites: 1. you have successfully aquired research funds ( > 50.000 or a PhD position ) 2. must not have had your main residence in Germany for more than 12 months during the three years prior to the application deadline
Residence in from until

5 year Research Fellowship___________________________________________________________ Prerequisites: you have successfully aquired research funds ( > 50.000 or a PhD position ) OR an application is pending (offer will be made conditional) Your own salary at the university is already secured for part or the entire duration of the proposed fellowship if YES, please enter funding source and secured funding period from until yes no yes no

If you apply for a 5 year Research Fellowship and your application for a research grant is still pending would you consider a 2 year fellowship should the grant not or not yet be funded?

2 year Postdoctoral Fellowship_________________________________________________________ Prerequisites: you have obtained a doctoral degree (PhD or equivalent)

4. Funding
Acquired funding

Funding agency

Duration of project
from until

Approved amount

Pending applications for external funding

Funding agency

Duration of project
in month Expected decision date

Requested amount

BW-Bank Konstanz, Kontonr. 7 486 501 274 BLZ. 600 501 01 IBAN: DE92 6005 0101 7486 5012 74 BIC: SOLA DE ST Paketanschrift: Universitt Konstanz, Universittsstrae 10, 78464 Konstanz

5. Skills and competences (please specify)

Interdisciplinary experience:

Experience in knowledge-transfer / teaching:

Experience in organizing conferences, workshops, etc.:

Work in committees:

6. Extra academic experiences

Extra-academic employment (e.g. in industry):

Parental leave:

BW-Bank Konstanz, Kontonr. 7 486 501 274 BLZ. 600 501 01 IBAN: DE92 6005 0101 7486 5012 74 BIC: SOLA DE ST Paketanschrift: Universitt Konstanz, Universittsstrae 10, 78464 Konstanz

7. Details of the proposed research project

Project title:

Keywords: Preferred department at the University of Konstanz:

8. Abstract in english

BW-Bank Konstanz, Kontonr. 7 486 501 274 BLZ. 600 501 01 IBAN: DE92 6005 0101 7486 5012 74 BIC: SOLA DE ST Paketanschrift: Universitt Konstanz, Universittsstrae 10, 78464 Konstanz

9. Publications
Please list your 5 most important and influencial publications

BW-Bank Konstanz, Kontonr. 7 486 501 274 BLZ. 600 501 01 IBAN: DE92 6005 0101 7486 5012 74 BIC: SOLA DE ST Paketanschrift: Universitt Konstanz, Universittsstrae 10, 78464 Konstanz

10. Ethical considerations

Does the research project raise ethical issues? If so, please explain how this will be addressed so as to conform to national and FP7 ethical principles in the project outline. yes no

11. References
Please name two people who know you well and will write a letter of reference on your behalf. Please arrange for these letters to be sent to zukunftskolleg@uni-konstanz.de within 7 days after the application deadline. Name of referee Address E-mail

Name of referee

Address

E-mail

Please name two potential peer reviewers for your research project. People with conflicts of interests, supervisors, collaborators should be excluded. Name of proposed peer reviewer Address E-mail

Name of proposed peer reviewer

Address

E-mail

Please name one person at the University of Konstanz who can judge your merits. Name of judge Address E-mail

BW-Bank Konstanz, Kontonr. 7 486 501 274 BLZ. 600 501 01 IBAN: DE92 6005 0101 7486 5012 74 BIC: SOLA DE ST Paketanschrift: Universitt Konstanz, Universittsstrae 10, 78464 Konstanz

We would like to draw your attention to the fact that the personal information you provide will be stored and processed in a computer database. During the selection procedure, your details will be made available to external referees and members of the selection committee. The name, project title, abstract, and contact details of all successful applicants to the Zukunftskolleg will be published on the website of the Zukunftskolleg. Please save this application form as "Surname_name_Zukunftskolleg_2012.pdf". Please assemble in an additional single pdf file the following material: 1. Motivation letter (1 page) 2. Project outline (6 pages max.) 3. Curriculum vitae 4. Relevant degree certificates 5. Publication / writing sample (30 pages max.) Save this file as "Surname_Name_Documents_2012.pdf". Please send both files with the reference number of the respective call in the subject line of the E-mail to zukunftskolleg@uni-konstanz.de. Please arrange for the two reference letters to be sent to zukunftskolleg@unikonstanz.de within 7 days after the application deadline. Contact details If you have any queries, please contact the Zukunftskollegs Central and Coordination Office at zukunftskolleg-application@uni-konstanz.de. Our team will be happy to assist you!

BW-Bank Konstanz, Kontonr. 7 486 501 274 BLZ. 600 501 01 IBAN: DE92 6005 0101 7486 5012 74 BIC: SOLA DE ST Paketanschrift: Universitt Konstanz, Universittsstrae 10, 78464 Konstanz