APPLICATION FORM

Summer Program in Taiwan 2013
for Italian Graduate Students

 (This application must be typewritten.)

PERSONAL INFORMATION:

Full Name (Last Name, First name and Middle Name):

Sex:

Date (dd/mm/yyyy) and place of birth: 

Nationality:

Current address:

Permanent home address:

Telephone: 

E-mail address 1:
E-mail address 2:

CURRENT ACADEMIC INSTITUTIONAL ADDRESS:

Department		
Institution		
Address	
	
Office Phone	+39 ________________  Fax  +39 ___________________	
Date (MM/YYYY) when you began graduate studies ______________________________
Current Degree Program: PhD. _____ Master _____ Other _________________

RECOMMENDATIONS TO BE OBTAINED FROM:
Name	____________________________________________________	
Department	____________________________________________________	
Institution	____________________________________________________	
Phone/Fax/E-mail	____________________________________________________	

Name	______________________________________________________	
Department	______________________________________________________	
Institution	______________________________________________________	
Phone/Fax/E-mail	____________________________________________________	

PREVIOUS VISITS TO TAIWAN (place, year, duration and purpose):
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
POSITIONS AND AWARDS IN THE LAST THREE YEARS:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

CHINESE LANGUAGE BACKGROUND: Specify courses taken (university level), details of other training (including self-instruction), and any particular strength you might have in the language. Please note this information is required for planning the language instruction in Taiwan and that proficiency in the foreign language is not a prerequisite for participation in the Summer Program. 
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I have read this program announcement in detail and have noted the conditions herein.
Signature of Applicant: _________________________________ 
Date: 
POTENTIAL HOST INSTITUTIONS
List potential host institutions in priority order, and include names and complete contact information of potential host scientist(s) if available. 
1.
2.
3.
4.
The host institution should be confirmed before at the time of application deadline (February 15, 2013).

DATES OF TRAINING
(If you plan to stay longer than July 1 ~ August 23, 2013)
Dates:

STATEMENT OF PURPOSE
(Explain your unique qualifications for participation in the Summer Program and list the benefits the program will provide to your professional development. May not be exceeding one page).
NAME OF APPLICANT: _____________________________

DESCRIPTION OF CURRENT STUDIES
(Provide a summary of your current studies and/or research projects, and interests. Please write the summary for a technical audience and identify both a general field of study and any specific research interests. May not be exceeding one page.)
NAME OF APPLICANT: _____________________________

RECOMMENDATION FORM 
NAME OF APPLICANT:	___________________________________________	
RECOMMENDER:	___________________________________________	
Name:	___________________________________________	
Department:	___________________________________________	
Institution:	___________________________________________	

1. How long, and in what capacity, have you known the applicant?

2. In specific terms, explain how the Summer Program will benefit to the applicant. What unique approaches, opportunities, or skills will the applicant obtain in Taiwan?

3. Briefly describe the applicant’s research contributions, the quality of the research, and the potential significance of the research to your discipline or field.

4. I rank this applicant in the top _____ (percent) among _______ (number) of graduate students I have supervised over the last _____ (number) years.

5. Please check one of the two statements below. 
A. ____ my identity and this report must be held in confidence.
B. ____ this report may be released to the applicant upon request.

6. [For the Applicant’s Academic Advisor only.] I have read and understood the terms and conditions of the Summer Program in Taiwan, and I endorse my student’s full participation in the program.

_______________ (Initials here)

SIGNATURE: _________________________________________ 
DATE: _________________

Please send the completed recommendation form to:
Service Sciences et Technologies
Bureau de Représentation de Taipei en France
78 rue de l’Université
75007 Paris
France

Do not return to applicant. Recommendations must be postmarked by February 15, 2013. Failure to return this form in a timely fashion will jeopardize the application.)