Professional Position

Application for Category

1. PERSONAL DETAILS

Last Name First Name Middle Name

Gender Passport No.

Citizenship Residence

Date Awarded Institution

Department Title/Rank

2. CONTACT INFORMATION

Office Information Home Information

Address Address

Tel Fax Tel

E-mail E-mail

Preferred address for correspondence:

Name Relationship Tel

University/ College Department Degree Major

CAS President’s International Fellowship Initiative（PIFI）-Application Form-

Complete all parts of this form in typescript as a Microsoft Excel file. You are also required to send a printed and signed copy to your main CAS host researcher for submition to CAS PIFI Program office.

Date of Birthdd/mm/yyyy

Nationality(Birth Country)

Highest Degre Earned

Current Employer

PLEASE NOTE: If your application is successful, the photograph attached here may be used by CAS PIFI Program database and literature.

Name and address of next of kin or person in your country who should be contacted in the event of an emergency

3. EDUCATIONAL QUALIFICATIONPlease list all academic qualifications obtained since completing your secondary education

Full Professor Associate Professor Assistant Professor Postdoctoral Researcher

A: Distinguished Scientist C: Postdoctoral Researcher

Office Address Home Address

B: Visiting Scientist

Insitution Department Field Title

5. ACADEMIC BACKGROUND

Accomplishement obtained in the last 5 years in chronological orders(starting from the latest)

1. Projects(as a project leader or a participant)

2. Publication

3. Patents

4. Awards

5. Others

6. CAS HOST INSTITUTIONS AND RESEARCHERS

Main CAS Host Institute

Institute/University, Division

Host Researcher E-mail

Tel Fax Phone(M)

Institute/University, Division

Host Researcher E-mail

Tel Fax Phone(M)

4. PROFESSIONAL RECORD IN CHRONOLOGICAL ORDER Please list all positions held after completing your university education, including career breaks

Scientific field you are now working on

2nd CAS Host Institute(If you have)

Management SciencesHealth Sciences

Life Sciences Earth Sciences Engineering&Material Sciences

Chemical Sciences Informaiton Sciences

Others

Mathematical&Physical Sciences

7. ACADEMIC ACTIVITIES AND RESEARCH PROPOSAL

1. What is your motivation to undertake the CAS PIFI program?Please respond in no more than 200 words.

Title of the lecture:

Abstract(no more than 300 words)

Timetables(dates of visit and key activities)

Title of the research project:

Summary of research proposal at CAS(300 maximum )

Timetables(dates of visit and the work of collaboration)

From dd mm yyyy To dd

1

2

Total

9. LANGUAGE PROFICIENCY (5: excellent ………1: poor)

English

Reading

Chinese

Reading

Writing Writing

Hearing Hearing

Speaking Speaking

2. Lecture tour information (Only for Distinguished Scientist )

Whether you accept CAS's return visit?

3.Research project information (Only for Visiting Scientist and Postdoctoral Researcher)

8. PROPOSED TENURE AT CASCAS PIFI program is normally offered during the calendar year(from 1st, January-31st, December).Please start your visit at CAS before 31st, December each year.

Others(Indicate)

Week(s) Month(s)

YES NO

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

10. PAST CAS FELLOWSHIPS RECORD

Type of fellowship Amount($) Date CAS Host Institution

2. Outcomes resulting from the above fellowship

No. Name(as in Passport) Relationship Passport NO. Date of Issue12

12. WHERE ARE YOU HEARD OF THE PROGRAM

13. RESEARCH PROPOSAL AND SUPPLEMENTAL DOCUMENTS

14. Declaration:

Signature Date

1. Have you ever received any fellowship support from the CAS?If so, please indicate.

11. Will you be accompanied by spouse and/or offspring(s)?If so, please complete corrsponding information.

CAS PIFI Program Office endeavours to provide fellowship information to a widest audience. You feedback will be helpful to us to improve our work. Please take a few minutes to answer the following questions.(Multiple answers are okay)

Please submit the following documents along with this application form.1.A recent passport-sized digital photograph (in colour) 2.Photocopies of academic certificates3.Curriculum vitae4.Research proposal(except applicants for distinguished scientist), including : objective;detailed description of project; timetable; the reason for this collaboration5.Two recommendation letters(only applicants for postdoctoral fellows ), one recommendation must be prepared by your former supervisor

I hereby declare that the above information is accurate and correct.I authorise the CAS PIFI program office to eletronically store and process my personal data for the purpose of assessment, statistics and evaluation organized by Bureau of International Cooperation,CAS.I promise to conduct the academic visit at CAS as I stated above.

YES NO

Article, Adverts in magazine, newsletterInternet search

Proposed host PIFI Fellows Chinese embassy in your country

CAS website Work colleagues

Others

Friends or acquaintances

Professional Position

Application for Category

1. PERSONAL DETAILS

2. CONTACT INFORMATION

Home Information

Fax

Phone(M)

CAS President’s International Fellowship Initiative（PIFI）-Application Form-

Complete all parts of this form in typescript as a Microsoft Excel file. You are also required to send a printed and signed copy to your main CAS host researcher for submition to CAS PIFI Program office.

Colour PhotographPlease copy and paste your digital passport photo here

PLEASE NOTE: If your application is successful, the photograph attached here may be used by CAS PIFI Program database

Name and address of next of kin or person in your country who should be contacted in the event of an emergency

lease list all academic qualifications obtained since completing your secondary education

From(mm/yy) To(mm/yy)

Assistant Professor Postdoctoral Researcher

C: Postdoctoral Researcher

Home Address

5. ACADEMIC BACKGROUND

Accomplishement obtained in the last 5 years in chronological orders(starting from the latest)

1. Projects(as a project leader or a participant)

2. Publication

3. Patents

4. Awards

5. Others

6. CAS HOST INSTITUTIONS AND RESEARCHERS

Main CAS Host Institute

Room No.

Room No.

4. PROFESSIONAL RECORD IN CHRONOLOGICAL ORDER lease list all positions held after completing your university education, including career breaks

From(mm/yy) To(mm/yy)

CAS Host Institute(If you have)

Engineering&Material Sciences

Others

Mathematical&Physical Sciences

7. ACADEMIC ACTIVITIES AND RESEARCH PROPOSAL

1. What is your motivation to undertake the CAS PIFI program?Please respond in no more than 200 words.

Title of the lecture:

Abstract(no more than 300 words)

Timetables(dates of visit and key activities)

Title of the research project:

Summary of research proposal at CAS(300 maximum )

Timetables(dates of visit and the work of collaboration)

mm yyyy

9. LANGUAGE PROFICIENCY (5: excellent ………1: poor)

(Only for Distinguished Scientist )

(Only for Visiting Scientist and Postdoctoral Researcher)

CAS PIFI program is normally offered during the calendar year(from 1st, January-31st, December).Please start your visit at CAS before 31st,

NO

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

5 4 3 2 1

10. PAST CAS FELLOWSHIPS RECORD

CAS Host Institution Collaborator

2. Outcomes resulting from the above fellowship

Place of Issue Expiry Date

12. WHERE ARE YOU HEARD OF THE PROGRAM

13. RESEARCH PROPOSAL AND SUPPLEMENTAL DOCUMENTS

14. Declaration:

1. Have you ever received any fellowship support from the CAS?

11. Will you be accompanied by spouse and/or offspring(s)?

CAS PIFI Program Office endeavours to provide fellowship information to a widest audience. You feedback will be helpful to us to improve our work. Please take a few minutes to answer the following questions.(Multiple answers are okay)

Please submit the following documents along with this application form.1.A recent passport-sized digital photograph (in colour)

4.Research proposal(except applicants for distinguished scientist), including : objective;detailed description of project; timetable; the

5.Two recommendation letters(only applicants for postdoctoral fellows ), one recommendation must be prepared by your former supervisor

I hereby declare that the above information is accurate and correct.I authorise the CAS PIFI program office to eletronically store and process my personal data for the purpose of assessment, statistics and evaluation organized by Bureau of International Cooperation,CAS.I promise to conduct the academic visit at CAS as I stated above.

NO

Chinese embassy in your country

Friends or acquaintances