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ROTHSCHILD FELLOWSHIPS

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					                              Environment and Health Fund
                              Post-Doctoral Fellows Program
                                        Application Form
                                           January 2010

Please use this digital form and send the information saved as WORD document only.

A. PERSONAL DATA

Full name (English) _______________________________
Full name (Hebrew) _______________________________
Mailing address: (Hebrew) ____________________________
Permanent address (if it differs from the above) _______________________________
E-mail __________________________________________
Telephone: Home __________________Work____________________
Mobile phone ___________________
Date and place of birth _______________________________

Date of arrival in Israel (if applicable) __________________________________________

Family status __________________________________________

Present appointment or employment __________________________________________

For PhD Graduates:
Doctoral thesis title _______________________________
Department/Faculty _______________________________
University _______________________________
Date of approval of doctoral thesis ________________________________
Name and full contact information of doctoral supervisor
____________________________________________________________


For MDs:
Stage of medical career_______________________________
Specialisation ______________________________________
Institutional Affiliation _______________________________


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Title of most recent medical research study
_______________________________
Title of most recent medical research publication, if applicable
_______________________________

B. RESEARCH GROUP PREFERENCE/AFFILIATION

A concise list of the research groups interested in hosting suitable EHF post-doctoral fellows appears
in the “Guidelines for Applicants.”
A comprehensive list of the research groups, including details of the specific research projects, the role
of the post-doctoral fellow and their desired background appears in "Research Openings 2009.”

    Please list the name of the research opening for which you are applying.
     List the name of the institution, research group lead scientist and the proposed research project.

       For research openings at CREAL, please state the research program for which you are applying.

    If there are a number of potential placements of interest, please give a ranked preference (up to
     three) listing the institution, the research group’s lead scientist and the proposed research
     projects.

    Please state when you propose to commence your research abroad.

For applicants wishing to pursue post-doctoral research in groups or institutions other than those listed.

   Please state the name of the research group, department and host institution where you propose
    conducting your post-doctoral research. Please attach your letter of invitation (even if acceptance
    is conditional upon funding).
   Please state when you propose to commence your research abroad.
   Please elaborate on your planned research activities abroad. Include the reasons for your choice
    of country, institution and academic supervisor abroad (up to one page).

C. ACADEMIC CREDENTIALS

1. Please provide a brief summary of your PhD dissertation research (up to one page).

2. Please detail your present studies or research if different from the PhD thesis (up to one page).

3. Statement of Mission: Please write a short statement (up to 1 page) summarizing your motivation to
pursue post-doctoral research in your field of choice. Please include
   your current research interests
   the link between your interests, the project you will be working on and planned future work
   what will lead you to believe that your post-doctoral studies have been successful, when they are
    completed
   what you intend to do upon your return to Israel and how your post-doctoral research advances
    this intent
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D. FINANCES
If relevant, please provide the following details regarding finances:
Provide details regarding a salary, scholarship, fellowship, grant, study allowance or any other payment
you expect to receive from your present university, any other institution or other employer during your
proposed period of study or research abroad.

E. OTHER INFORMATION
Add here any other information which you consider relevant (up to 1 page).

F. REFEREES
State the name, affiliation, e-mail address and telephone number of the three referees from whom you
have requested letters of recommendation.
PhD graduates:
Referee #1: Doctoral degree advisor
____________________________________________________________

Referee #2: Senior academic in the applicant’s academic discipline who is not at the applicant’s
university.
____________________________________________________________

Referee #3:
____________________________________________________________

MDs should provide references from senior academics in the applicant’s research discipline
Referee #1: Senior academic in the applicant’s research discipline who is not at the applicant’s
affiliated institution.
____________________________________________________________

Referee #2:
____________________________________________________________

Referee #3:
____________________________________________________________




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