IANAS Fellowship Application

IANAS Fellowship Application
Given/First Name(s):
Middle Name:
Family/Surname(s):
Institution Name:
Email Address:
Address Line 1:
Telephone Number:
Address Line 2:
Date of Birth:
City, State or Province:
Citizenship:
Postal Code:
Male
Female
Country:
U.S. Host Institution Support
Name of host institution in the U.S:
Name(s) of host researcher(s) in the U.S:
Job title(s) of host researcher(s) in the U.S:
Address of host institution:
City, state, zip code of host institution:
Research area/field:
One line description of proposed research:
Proposed dates of stay in the U.S. – from:
to:
Home Institution Support
Name of person writing letter of support at your home institution:
Letter writer’s relationship to you (supervisor, director, president, etc):
___________________________________________
Signature or E-signature
I hereby certify that the information contained in this application is true and accurate.
Please include in your application package the following (see the online instructions for details):
1.
2.
3.
4.
CV – limited to 5 pages
A Statement of Interest/Proposed Research – limited to 2 pages
A letter of support from your host institution in the United States – limited to 2 pages
A letter of support from your institution of employment in your home country – limited to 2 pages
Follow the instructions below for submission to your country:
Countries with an Academy of Science representation:
Argentina – National Academy of Exact, Physical and Natural Sciences (ANCEFN)
Contact: [email protected]
Bolivia – Academia Nacional de Ciencias de Bolivia
Contact: [email protected]
Brazil – Brazilian Academy of Sciences
Contact: [email protected]
Caribbean – The Caribbean Academy of Sciences (CAS)
Contact: [email protected]
Chile – Academia Chilena de Ciencias
Contact: [email protected]
Colombia - Colombian Academy of Exact, Physical and Natural Sciences
Contact: [email protected]
Costa Rica - Academia Nacional de Ciencias – Costa Rica
Contact: [email protected]
Cuba - Academy of Sciences of Cuba
Contact: [email protected]
Dominican Republic - Academia de Ciencias de la República Dominicana
Contact: [email protected]
Guatemala - Academia de Ciencias Medicas, Físicas y Naturales de Guatemala
Contact: [email protected]
Mexico - Academia Mexicana de Ciencias
Contact: [email protected]
Nicaragua - Nicaraguan Academy of Sciences
Contact: [email protected]
Peru - Academia Nacional de Ciencias del Perú
Contact: [email protected]
Venezuela - Academia de Ciencias Físicas, Matemáticas y Naturales de Venezuela
Contact: [email protected]
Caribbean and Latin American Countries with no Academy of Sciences represented:
IANAS Secretariat
Contact: [email protected]