CALL FOR SCHOLARSHIPS OF THE MEXICAN GOVERNMENT FOR FOREIGNERS 2013

PICTURE

ACTIVITY TO BE PERFORMED IN MEXICO

IN CASE OF APPLYING FOR AN ACADEMIC PROGRAM SCHOLARSHIP, PLEASE FILL IN THIS SECTION:

Complete name of the intended postgraduate or research program: ______________________________________

____________________________________________________________________________________________
Institution: _______________________________________ Intended Educational Degree: ___________________
Program starting date: _______/_____/_______ Program finishing date: ______/______/_______
Day

Month

Year

Day

Month

Year

If you have already started the course, indicate:

Starting date: ___________________ Current academic term: _________________________________________
Current grades __________________
Specific term for the intended scholarship: __________________________________________________________
It is essential to enclose the supporting documents.
____________________________________________________________________________________________

IN CASE OF APPLYING FOR AN SPECIAL PROGRAM SCHOLARSHIP, PLEASE FILL IN THIS SECTION:
Type of academic activity for the intended scholarship:
( ) Lecturer
( ) Visiting Professor
( ) Media Contributor

(
(

) Researcher
) Art Fellowship

Name of the conference, course, seminar, research, art or press work to be performed:
___________________________________________________________________________________________
___________________________________________________________________________________________
Host institution: ______________________________________________________________________________

DO NOT USE HANDWRITING-

Activity starting date: _______/_______/________

Day

Month

Activity finishing date: ________/________/________

Year

Day

Month

Year

APPLICANTS GENERAL INFORMATION

Name: ____________________________________________________________________________________
Last Name

Middle Name

First Name

Nationality: ________________________________________________________________________________
Gender:

(F)

(M)

Birthday: ______ /_____/____

Day

Month Year

Civil Status: Single ( ) Married ( )

Domicile: ____________________________________________________________________________________
Street and Number

Residential District / Locality

____________________________________________________________________________________________
City /Town Council

State / Province

Country

Zip Code

Telephone (with long distance code): _________________________ Office telephone: ______________________

Email: ______________________________________________________________________________________
(*) The Ministry of Foreign Affairs can officially contact you by email
Have you been awarded with a scholarship from the Mexican Government?

Yes ( )

No ( )

ACADEMIC OR ARTISTIC RESPONSIBLE AUTHORITY WHO CAN BE CONSULTED ABOUT THE ACTIVITY IN
MEXICO

Name: ____________________________________________________________________________________
Institution: _________________________________

Position: _________________________________

Telephone: __________________________________

Email: ___________________________________

Do you have any support to perform the activity for the intended scholarship of the Ministry of Foreign Affairs?
Si (

No (

From which institution: ______________________________ Term: _____________________________________

ACADEMIC INFORMATION
(Enclose supporting documents)

Bachelors Degree:_________________________________________

GPA: _______________________

Institution: __________________________________________ Start and end year: _________________________

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City and Country: _____________________________________

Masters Degree: _____________________________________

GPA: ______________________________

Institution: __________________________________________ Start and end year: _________________________

City and Country: ____________________________________
PhD Degree: ___________________________________________

GPA: ___________________________

Institution: __________________________________________ Start and end year: ______________________

City and Country: ____________________________________

Note: It is compulsory to provide the GPA.

Languages
Native language: ______________________________________________________________________________
Other languages: _____________________________________________________________________________
If the applicant speaks other language than Spanish, specify the level of Spanish language and enclose a document
issued by a Language Institution or University that proves it: _________________

EMPLOYMENT INFORMATION

Current activity:
Institution or Company: _____________________________ Position: ____________________________________
Starting date _____________________________________
Previous job:
Institution or Company: _____________________________ Position: ___________________________________
Seniority: ________________________________________

TEACHING, RESEARCH, OR ARTISTIC ACTIVITIES

Teaching, research, or artistic activities you have developed. Indicate their institution and dates:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

RECENT PUBLICATIONS

DO NOT USE HANDWRITING-

Mention the name of your three last publications related with the intended activity (indicate dates):
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
AWARDS, PRIZES, AND SCHOLARSHIPS

Awards, prizes, and academic recognition: _________________________________________________________

Academic or research scholarships granted abroad. Indicate the granting institution, country where the activity was
performed, and start and end dates: ___________________________________________________________
____________________________________________________________________________________________

IN CASE OF EMERGENCY

Notify to: ___________________________________________________________________________________

Relationship: ________________________________________________
Country: _____________________
Telephone (with long distance code):______________________________________________________________
Fax: _________________________________
Email: __________________________________
Domicile: ___________________________________________________________________________________

ACCEPTANCE

I accept the provisions of the Call for Scholarships of the Mexican Government for Foreigners 2012,
integrated by the Terms and Conditions for Foreign Recipients of the Ministry of Foreign Affairs.

______________________________________
Applicants signature

_______________________________________
Place and date

Note: The information stated in this application form will be verified by the Ministry. Any false information
will caused the application exclusion.

DO NOT USE HANDWRITING-