Reference No:(for official use)

Received on:(for official use)

How to complete the form

1. Please complete the application form in type, or write in CAPITAL letters and BLACK ink.

2. Please quote your e-mail address, as all correspondence will be via e-mail.

3. Please make a copy of the form for yourself before sending it to IUCEA/RFU.

4. Fill in all the sections, otherwise delays will occur when processing your application.

5. The closing date for fellowship applications to be received is June 4 2018. Fellowship applications received after the closing date will not be considered.

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Inter-University Council for East AfricaP O Box 7110, Kampala, Uganda

Tel: +256 773181662E-Mail: exsec@iucea.orgWebsite: www.iucea.org

MASTERS FELLOWSHIP APPLICATION FORM

Supporting Young Talented Female Scientists to Become Future Leaders

PLEASE ATTACH A

RECENT PASSPORT SIZE PHOTOGRAPH

(3x4)

A. Personal details (as they appear on your passport)

Last/family name:

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First name:

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Other names:

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Address:

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Phone: - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

E-mail: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Gender:

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Date of birth(day/month/year)

/ /

Passport No: - - - - - - - - - - -- - - - - - - - - - -

Place of Issue:- - - - - - - - - - -- - - - - - - - - - -

Date of Issue: - - - - - - - - - - -- - - - - - - - - - -

Date of Expiry:- - - - - - - - - - -- - - - - - - - - - -

Nationality of Birth

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Current Nationality

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B. Programme of study

Title of degree programme admitted to:

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Admission number:

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Name and address of university:

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Name of African Center of Excellence:

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C. Education history and qualifications

Please list qualifications and grades which you have already obtained starting with the most recent:

Dates attended

School, university or college / country

Qualification name (e.g. high school certificate, BSc in…) Grade/class Date

obtained

D. Work experience

Please describe any work experience which is relevant to your proposed study programme, starting with your most recent position:

Employment Dates

Name of employer/organisation Job title and responsibilities

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E. Publications, Conferences, awardsList articles you have published or presented in conferences, and award for outstanding achievement, if any.

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F. Personal statement

These fellowships are awarded on the basis of academic ability, future potential and relevance, and the selectors will pay special attention to the information you provide here. Please tell us about your academic achievements and ambitions. In particular, please explain why you have chosen your particular field of study and its importance to the region’s development:

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G. References

Name and Position Contact Address

H. Declaration

I hereby declare that I have understood and comply with the eligibility criteria, and I make a true statement about my details.

Signature (or type your name): Date:

I. Checklist

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i) Completed application form ii) Recent passport-size photograph iii) Summarized CV with names and contacts of two refereesiv) Certified copies of academic certificates and transcripts v) Certified copies of passport or national identity card indicating citizenship vi) Copy of admission letter from one of the host universities (please refer to the attached table

on Countries, ACEs and Universities)vii) Two (2) reference letters with contact addresses

In addition, applicants must scan and produce electronic copies of all the above documents (converted to PDF format) and send by e-mail to exsec@iucea.org with a copy to ace2rfu@iucea.org to be received by June 4 2018.