CAS Presidents International Fellowship InitiativePIFI

-Application FormComplete all parts of this form in typescript as a Microsoft Excel file. You are also required to send a printed
and signed copy to your main CAS host researcher for submition to CAS PIFI Program office.
Professional Position

Full Professor

Application for Category

Associate Professor

A: Distinguished Scientist

Assistant Professor

B: Visiting Scientist

Postdoctoral Researcher

C: Postdoctoral Researcher

1. PERSONAL DETAILS
Last Name

First Name

Middle
Name

Gender

Date of Birth
dd/mm/yyyy

Passport No.

Citizenship

Residence

Date
Awarded

Institution

Department

Title/Rank

Nationality
(Birth Country)

Highest
Degre Earned
Current
Employer

Colour Photograph
Please copy and paste
your digital passport photo
here

PLEASE NOTE: If your application is successful, the photograph attached here may be used by CAS
PIFI Program database and literature.

2. CONTACT INFORMATION
Office Information
Address

Home Information
Address

Tel

Fax

E-mail

Tel

Fax

E-mail

Preferred address for correspondence:

Office Address

Home Address

Name and address of next of kin or person in your country who should be contacted
in the event of an emergency
Name

Relationship

Tel

Phone(M)

3. EDUCATIONAL QUALIFICATION
Please list all academic qualifications obtained since completing your secondary education
University/ College

Department

Degree

Major

From(mm/yy)

To(mm/yy)

4. PROFESSIONAL RECORD IN CHRONOLOGICAL ORDER

Please list all positions held after completing your university education, including career breaks
Insitution

Department

Field

Title

From(mm/yy)

To(mm/yy)

5. ACADEMIC BACKGROUND
Scientific field you are now working on
Life Sciences
Earth Sciences

Engineering&Material Sciences

Chemical Sciences

Informaiton Sciences

Mathematical&Physical Sciences

Health Sciences

Management Sciences

Others

Accomplishement obtained in the last 5 years in chronological orders(starting from the latest)
1. Projects(as a project leader or a participant)

2. Publication

3. Patents

4. Awards

5. Others

6. CAS HOST INSTITUTIONS AND RESEARCHERS

Main CAS Host Institute
Institute/University, Division
Host Researcher
Tel

E-mail
Fax

Phone(M)

Room No.

2nd CAS Host Institute(If you have)

Institute/University, Division
Host Researcher
Tel

E-mail
Fax

Phone(M)

Room No.

7. ACADEMIC ACTIVITIES AND RESEARCH PROPOSAL

1. What is your motivation to undertake the CAS PIFI program?Please respond in no more than 200 words.

2. Lecture tour information (Only for Distinguished Scientist )

Title of the lecture:

Abstract(no more than 300 words)

Timetables(dates of visit and key activities)

Whether you accept CAS's return visit?

YES

NO

3.Research project information (Only for Visiting Scientist and Postdoctoral Researcher)
Title of the research project:
Summary of research proposal at CAS(300 maximum )

Timetables(dates of visit and the work of collaboration)

8. PROPOSED TENURE AT CAS

CAS PIFI program is normally offered during the calendar year(from 1st, January-31st, December).Please start
your visit at CAS before 31st, December each year.
From

dd

mm

yyyy

To

dd

mm

yyyy

1
2
Week(s)

Total

Month(s)

9. LANGUAGE PROFICIENCY (5: excellent 1: poor)

English

Reading

Writing

Hearing

Speaking

Reading

Writing

Hearing

Speaking

Chinese

Others(Indicate)

10. PAST CAS FELLOWSHIPS RECORD

1. Have you ever received any fellowship support from the CAS?
If so, please indicate.
Type of fellowship

Amount($)

2. Outcomes resulting from the above fellowship

Date

YES

NO

CAS Host Institution

Collaborator

11. Will you be accompanied by spouse and/or offspring(s)?

If so, please complete corrsponding information.
No.
1
2

Name(as in Passport)

Relationship Passport NO. Date of IssuePlace of Issue Expiry Date

12. WHERE ARE YOU HEARD OF THE PROGRAM

CAS PIFI Program Office endeavours to provide fellowship information to a widest audience. You feedback
will be helpful to us to improve our work. Please take a few minutes to answer the following
questions.(Multiple answers are okay)
PIFI Fellows
Chinese embassy in your country
Proposed host
CAS website

Work colleagues

Internet search
Others

Article, Adverts in magazine, newsletter

Friends or acquaintances

13. RESEARCH PROPOSAL AND SUPPLEMENTAL DOCUMENTS

Please submit the following documents along with this application form.
1.A recent passport-sized digital photograph (in colour)
2.Photocopies of academic certificates
3.Curriculum vitae
4.Research proposal(except applicants for distinguished scientist), including : objective;detailed description of
project; timetable; the reason for this collaboration
5.Two recommendation letters(only applicants for postdoctoral fellows ), one recommendation must be
prepared by your former supervisor

14. Declaration:
I hereby declare that the above information is accurate and correct.I authorise the CAS PIFI program office to
eletronically store and process my personal data for the purpose of assessment, statistics and evaluation
organized by Bureau of International Cooperation,CAS.I promise to conduct the academic visit at CAS as I
stated above.

Signature

Date