European Master Course Functionalized Advanced Materials and Engineering

Application Form for Third-Country Scholars FAME Master Scholarship 2011/2013

Application deadline: 10/01/2011
Max. 3 applications to Erasmus Mundus programs allowed

REMINDER: This Application Form is only used for scholars applying for teaching/research activities. NOT FOR STUDENTS.

The completed Application Form must be sent by Airmail and Electronic mail (see points 1) and 2) below). For the paper version, it has to be accompanied by the below-mentioned list of documents. All documents have to be translated in English and submitted with documents in the original languages (1 original document and 1 certified translation). Curriculum Vitae in the preformatted version Certified copy of your passport or identification card Certificate of employment in the current academic position Four recent publications on related subject area (if possible) Name and contact information of 2 referees
The application and accompanying documents will be kept by the FAME administration. Personal data will be stored by the FAME Consortium if necessary for the administration of applications. Applications of unsuccessful candidates will be destroyed after one year.

1) Please save the Application Form as a pdf or Word file under the following format
AF_Yourlastname.pdf (or.doc) as well as your Curriculum Vitae as a pdf or Word file under the format CV_Yourlastname.pdf (or.doc) and send both of them (AF and CV) to the following Email address: master.fame@grenoble-inp.fr

2) Please send your application together with all requested documents required before the deadline to:
Institut polytechnique de Grenoble (Grenoble INP) International Relations Department - FAME Master Program 46, avenue Flix Viallet F- 38031 GRENOBLE Cedex 1 - FRANCE

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Erasmus Mundus FAME Master Application Form

1. PERSONNAL DATA
Family name (last name)

ID picture

First name(s)

Sex (F, M)

Date of birth (dd/mm/yyyy)

Place of birth

Country of birth

Nationality(ies)

Permanent e-mail address (VERY IMPORTANT as we will contact you mostly by email)

Passport number (or other valid document; please specify which kind of document: passport ID, etc.) Validity until : Permanent personal address in your home country Street name and number: City: Postal Code: Country: Phone (with international code): Permanent address for all correspondence, if different from above Street name and number: City: Postal Code: Country: Marital status (single, married) Number of children Cell phone:

Personal present status (employed, unemployed, student, part-time)

If you have spent period(s) in Europe during the last 5 years, please specify where, how long and for which purpose

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2. LANGUAGE SKILLS
Specify languages in first column. Describe your language skills under the following columns with the marks: 0=no knowledge, 1=basic, 2=average, 3=advanced. Include your mother tongue (if other than English). Mother Tongue English (if not mother tongue) Fluent Writing Speaking Listening

If English is not your mother tongue, please justify sufficient proficiency in this language for teaching to the students of the FAME master in this language (max 300 words)

3. PRACTICAL OR PROFESSIONAL WORK EXPERIENCE

Describe, if any, your employment and/or professional experience during or after higher education. Please specify the date, position, main activities, employer address, sector, and specialty. Name and full address of employer
(specify country)

From

To

Position

Main activities or responsibilities

Specialty or subject
(if relevant)

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Erasmus Mundus FAME Master Application Form

Please indicate the names and full contact addresses of 2 academic referees (including telephone and email addresses), if available, connected to the FAME Network of Excellence. 1. Referee #1: Name: Address: Telephone: (international code) Email Referee #2: Name: Address: Telephone: (international code) Email

2.

4. MOTIVATION AND RESEARCH PROJECT

Explain why you are applying to the FAME Master teaching program. Discuss your motivations to teach abroad, your professional interests and your career goals and expectations. Include here any details about research activities you would like to lead in Europe as well as possible interactions you could have with teams involved in the FAME Master (not more than 2 pages).

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Erasmus Mundus FAME Master Application Form

5. TEACHING LOCATION PREFERENCE During Year 1 of Master FAME (Semester 1 and 2)

Choose your preferred option by marking one box (see details in the curriculum). Augsburg University Grenoble Institute of Technology

Or during Year 2 of Master FAME (Semester 3)

University Specialization Materials interfaces: Surfaces, Composites and Coatings Materials for Micro- and Nanotechnologies Nanomaterials and Hybrids Hybrid Materials and Ceramics: Design, Synthesis and Properties Functional Ceramics: Processing, Characterization and Properties Nanomaterials and Modeling Engineering of Materials and Nanostructures 1 2 3 4 5 6 7

Augsburg University Grenoble Institute of Technology Aveiro University Bordeaux University Technical University of Darmstadt Lige University Louvain University

6.

ADDITIONAL INFORMATION

Provide any additional information that may further improve your application. (e.g links with the FAME Network of Excellence or EMMI institute)

I declare and certify that the information provided in this application is accurate to the best of my knowledge and agree to inform immediately the FAME consortium about any changes and amendments. Furthermore I agree, if included in the FAME teaching team, to respect the FAME curriculum regulations. I accept responsibility for the completeness of my application. I hereby authorize the FAME consortium to treat the data provided to the purpose of the scholars selection for the FAME program. If I am awarded a FAME scholarship, I understand that I will be responsible for covering all costs related to travel, accommodation, etc during my stay within the FAME consortium.

___________________ Place, Date

___________________________________________ Signature

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