| 1. |
Personal details |
| 1.1 |
First name, last name and title(s) |
| 1.2 |
Gender |
| 1.3 |
Nationality |
| 1.4 |
Age, date and place of birth |
| 1.5 |
Private address and telephone |
| 1.6 |
Work address, telephone, telefax |
| 1.7 |
E-mail(s) for contact |
| 1.8 |
Position at work |
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| 2. |
Scientific education |
| 2.1 |
University entrance qualification or high school-leaving exam certificate (e.g. Abitur, A-Levels, Baccalaureat) including date, place, marks (i.e. the certificate which allows you to study at a university)
|
| 2.2 |
University studies (dates, universities, subjects, practical training, holiday courses, etc.) |
| 2.3 |
Intermediate and final examinations (dates, universities, marks) |
| 2.4 |
Diploma or equivalent thesis (project title, institute, supervisor, dates) |
| 2.5 |
PhD thesis (project title, institute, supervisor, dates) |
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| 3. |
Non-scientific activities |
| 3.1 |
Military or community service, maternity or paternity leaves (dates) |
| 3.2 |
Vocational (i.e. professional) training (dates, description) |
| 3.3 |
Employment (dates, description) |
|
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| 4. |
Current research project |
| 4.1 |
Title of research project currently pursued at home institution |
| 4.2 |
Location of current research project (university, institute, supervisor) |
| 4.3 |
Beginning of current research project (date) |
|
|
| 5. |
Planned training or course |
| 5.1 |
Title of planned training or course |
| 5.2 |
Location of planned training or course (full name and address of university, institute, and supervisor) |
| 5.3 |
Beginning and duration of training or course |
|
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| 6. |
Financial circumstances |
| 6.1 |
Calculation of expenses for travel, lodging, and/or course fees |
| 6.2 |
Applications submitted to other funding institutions |
| 6.3 |
Income of applicant (net per month, duration) |
|
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| 7. |
Source |
|
Where did you first find out about the Boehringer Ingelheim Fonds (e.g. personal recommendation of supervisor or B.I.F. fellow; internet, article in journals, meetings, fellowship reference books, other sources) |
|
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| 8. |
Information on projects or courses |
| 8.1 |
Title and summary of current research project including references (length: about 2 pages) |
| 8.2 |
Title of planned training and outline of your experiments in the host laboratory (about 2 pages), aim of the training and reasons for wishing to work with this particular group;
alternatively: title of course and statement of its impact on your future scientific career |
| 8.3 |
Statement in which you describe the connection with your current research project |
| 8.4 |
List of your publications (if available) |
|
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| 9. |
Additional documents to accompany your application |
| 9.1 |
Letter of recommendation from the supervisor of your current research project including a statement that your salary will be continued during the envisaged training |
| 9.2 |
Letter of acceptance from the supervisor of the host laboratory stating that the host institute will cover the research-related costs;
alternatively: letter of acceptance from the organizers of the scientific course including details of tuition fees and other costs |
| 9.3 |
Estimate of expenses for travel issued by a travel agent and/or internet agency |
| 9.4 |
University entrance qualification or high school-leaving exam certificate (photocopy/Xerox) |
| 9.5 |
Certificates of all examinations (e.g. Diploma, BSc, MSc). |
