附表2-PIFI申报英文申请表.xls

CAS President’s International Fellowship Initiative（PIFI） -Application Form（for foreign applicants） Please fill in this form and send both electronic and printed copy with handwritten signature to your main CAS host researcher for submission to CAS PIFI Program office. Please be aware of that duplicated application is not accepted, you have to make sure ONLY one institute submits your application. Associate Professor Full Professor Position Title Distinguished Scientists Application Category Assistant Professor Visiting Scientists PERSONAL DETAILS Last Name Gender Nationality (Birth Country) Middle Name First Name Date of Birth dd/mm/yyyy Citizenship Passport No. Colour Photograph Please copy and paste your digital passport photo here Residence Highest Degree Date Awarded Institution Current Employer Department Title/Rank PLEASE NOTE: If your application is successful, the attached photograph may be used by CAS in the PIFI Program database and literature. CONTACT INFORMATION Office Information Address Tel Home Information Address Fax Tel E-mail Fax E-mail Preferred Contact Address Home Address Office Address In case of emergency, please provide us with contact information of family member or relatives in your country of residence. Name Relationship Tel Phone(M) EDUCATIONAL QUALIFICATION Please list all academic qualifications obtained since completion of secondary education University/ College Department Degree Major From(mm/yy) To(mm/yy) PROFESSIONAL EXPERIENCE Please list all career experiences after graduation from univeristy in chronological order, including career gap period Insitution Department Field Title From(mm/yy) To(mm/yy) ACADEMIC BACKGROUND Scientific field you are now working on Life Sciences Earth Sciences Engineering & Material Sciences Chemical Sciences Information Sciences Mathematical & Physical Sciences Health Sciences Management Sciences Others Accomplishement obtained in the last 5 years in chronological orders(starting from the most recent) 1. Projects(as a project leader or a participant) 2. Publication 3. Patents 4. Awards 5. Others CAS HOST INSTITUTIONS AND RESEARCHERS CAS Host Institute Institute/University, Division Host Researcher Tel E-mail Fax Phone(M) Room No. ACADEMIC ACTIVITIES AND RESEARCH PROPOSAL 1. Lecture tour information (Only for Distinguished Fellow ) Title of the Lecture: Abstract(no more than 300 words) Timetables(dates of visit and key activities) Whether you accept CAS's return visit? No Yes 2. Research project information (Only for Visiting Fellow) Title of the research project: Summary of research proposal at CAS(300 maximum ) Timetables(dates of visit and the work of collaboration) PROPOSED TENURE AT CAS CAS PIFI program is normally offered during the calendar year (from 1 January to 31 December). Please start your visit at CAS before 31 December of each year. From dd mm yyyy To dd mm yyyy 1 2 Total Month(s) Week(s) LANGUAGE PROFICIENCY (5: excellent ………1: poor) Reading 5 4 3 2 1 Reading 5 4 3 2 1 Writing 5 4 3 2 1 Writing 5 4 3 2 1 English Chinese Listening 5 4 3 2 1 Listening 5 4 3 2 1 Speaking 5 4 3 2 1 Speaking 5 4 3 2 1 Others(Indicate) PAST CAS FELLOWSHIPS RECORD 1. Have you ever received any fellowship support from theYesCAS? If so, please indicate. Type of fellowship Amount($) Date No CAS Host Institution Collaborator 2. Outcomes achived in the above fellowship RESEARCH PROPOSAL AND SUPPLEMENTAL DOCUMENTS Please submit the following documents along with this application form. 1.A recent passport-sized digital photo(in colour) 2.Copy of first page of passport with personal information 3.Curriculum vitae 4.Research proposal(except applicants for distinguished scientist), including : objective;detailed description of project; timetable; reason for this collaboration 5.Recommendation letter. A recommendation letter issued by Chinese collaborator is required when applying for visiting scientist and distinguished scientist project. DECLARATION I am willing to visit/conduct research at the Chinese Academy of Sciences through the support of the CAS President’s International Fellowship Initiative (PIFI) and make the following commitments: 1. I promise that all the application materials I submitted are true, valid, complete and accurate, and will be responsible for all consequences of having provided any untrue information; 2. The information provided in the forms and other documents submitted during my application is allowed to be kept by the Chinese Academy of Sciences and used for internal data analysis processing, evaluation, etc.; 3. My work and any possible scientific research output during the implementation of the PIFI project will not conflict with any contract or contract terms that I am committed to or associated with. If there is a violation, I will be responsible for breach of contract or infringement; 4. My current employer has allowed me to apply for the PIFI program and understands and agrees to the content and duration of my visit and cooperation in China. I understand that I will receive additional personal income from PIFI funding and undertake all consequent commitments. I will be fully responsible for all consequences arising from any untrue statement; 5. I have no criminal record in my country or outside my country. I understand that the PIFI project will be implemented under the various legal frameworks of the People's Republic of China, and I am willing to abide by the relevant laws; 6. I fully understand the requirements of applying for PIFI, and have voluntarily executed this document. Signature Date Hereby declared.