RCA Post-doctoral Fellowship Programme by wuxiangyu

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									 Annex 1
                                         Application Form for the
                    RCARO Post-doctoral Fellowship (Training) Programmme



 1. Name in full:
                          (Last)         (First)          (Middle)                (Photo)
 2. Current position:


 3. Current institution :



 4. Gender                 5. Nationality                 6. Date of Birth     7. Place of Birth
      M/F

8. Marital status:       Married (       )         Single (     )
9. Passport Number :

10. Title of research project which the applicant hopes to participate in:
                Title:
1st priority



                Title:
 nd
2 priority



                Title:
 rd
3 priority



11. Proposed duration (within the 2007 fiscal year):


From:                              To:                          Total:       months



12. Name of Airports which the participant will depart from and arrive at:


            From:                                         To:



                                                         1
13. Educational background
     Name of Institution             Major Field          Academic Degree        Year




14. Foreign language proficiency
   (please evaluate yourself by writing “excellent”, “good”, “fair”)

     Language                 Speaking                 Writing              Reading




15. Major publications including master’s/doctoral theses:




16. Past and current research activity:




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17. Research plan under the post-doctoral programme in Korea:




18. Contact addresses
   (1) Office:
                                                 (Tel:          )
                                                 (Fax:              )
                                                 (E-mail:       )
   (2) Home:



                                                 (Tel:          )

19. Signature of the applicant




                             Signature:


                             Date     :




                                            3
20. Recommendation by the National RCA Representative
    1) In order to offer the participants the opportunity to contribute to their countries’
      national R&D activities or related policies, it is desirable that he/she is from a
      government-supported R&D Institute and could be involved in these Institutes’
      R&D activities after returning to his/her home country. In this regard, please state
      the plans for the fellow (trainee) after the programme is completed.




    2) Other Comments to the RCA Regional Office, if any




    3) Name and Title of the National RCA Representative:
      - Name:
      - Title:


                                  Signature: __________________________


                                  Date : __________________________




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Annex 2
                                         Medical Record



Name:
Age:               Gender:                  Height:              Weight:
1)   If the applicant has a history of illness or other disorders during the last five years,
     please describe treatment and present status.



2)   List any abnormalities indicated in the chest X-ray.



3)   What is the applicant’s normal blood pressure?



4)   Is the applicant free from infectious disease (AIDS, tuberculosis, trachoma, skin
     disease, etc.) ?



5)   Is the applicant able physically and mentally to carry on intensive research projects
     away from his/her home?



6)   Describe the applicant’s overall health condition (include remarks of the examining
     physician).




Name and address of clinic:
                               Date                  :
                               Name of physician :


                               Signature             :




Date:                              Signature of the applicant:




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