Both Terms ____________Fall
Term only _____________Spring Term only______________
Full Name ______________________________________ Date
__________________________
Permanent Address_____________________________________________________________
______________________________________________________________________________
Telephone Numbers: Office _______________________ Home_________________________
E-mail: _________________________________________ Fax:_________________________
Citizenship: ________________ Place of Birth:
______________ Date of Birth:___________
To help us assist you in finding suitable lodging in Philadelphia,
please indicate whether
your partner/family will accompany you: Partner/Spouse:
____ Children____
Number of Children ____
Ages of Children___________
Academic Degrees (Please give date and place received):
B.A. ________________________________________________________________________
M.A. ________________________________________________________________________
Ph.D. ________________________________________________________________________
Present Position (include institution): ______________________________________________
______________________________________________________________________________
Proposed Research Project (title and brief description):
_____________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
References: Names of three people who know your work. Please
ask them to send letters of recommendation directly to the Center by
the deadline of November 1, 2005.
Name and Position Address
_____________________________ ____________________________________________
_____________________________ ____________________________________________
_____________________________ ____________________________________________
_____________________________ ____________________________________________
____________________________ _______________________________________
____
_____________________________ ____________ _______________________________
Intended Research: Please submit with this application a brief description
(750-1000 words) of
your intended research project as indicated above.
PLEASE INCLUDE A CURRENT C.V.
Please return this form via mail or fax no later than November 1, 2005
to:
Administrator, Fellowship Program
Center for Advanced Judaic Studies
420 Walnut Street
Philadelphia, PA 19106
USA
|