This document can be completed in French or in English I – Your profile icon

This document can be completed in French or in English I – Your profile




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Department of cooperation and cultural action of

the French embassy in Kiev


Application form

Scholarship for a «short-term research stay»


This document can be completed in French or in English


I – Your profile

1) Personal information


Last Name* First name*




Date of birth*




Residence*




Email*




Mobile phone




^ 2) Current situation


Last diploma obtained*:

 Master's / Specialist's degree

 PhD (kandidat nauk)

 PhD (doktor nauk)

 Other


If other, specify :




Actual status*:

 PhD

 Researcher

 University teacher / researcher

 Other


If other, please specify:




^ 3) Previous funding


Have you ever benefited from a scholarship of the French Government?*

 Yes  No


If yes, which one?



when?




^ II – Your project

1) Context


Partnership

Organization (in Ukraine)*:




Organization (in France)*:




Have those organizations already developed partnership relationships?*:

 Yes  No


If yes, what does this partnership consist of and what are its main achievements?




Possible co-funding

Is there any additional support (from one of the partners or other organizations) planned for your project?*

 Yes  No


If yes, what kind of support is planned?


 Scholarship supplement

By whom?




 Extension of the duration of your stay

By whom?




 Accommodation

By whom?




 Transport

By whom?




 Other (specify):



By whom?




Your comments, if any




^ 2) Research project


Field (ex: physics)*




Specialisation (ex: particle physics)*




Please sum up (10-15 lines) your research project during your stay




^ 3) the project added value


In what sense should this stay in France be considered as decisive to implement your project? What are the expected results?





Please argue the interest of your stay:

a) for yourself, personally


b) for your organization (in Ukraine)




c) for your host organization (in France)




d) to improve on scientific and university cooperation between France and Ukraine




^ 4) Duration and organization of your stay


Duration of the scholarship requested for*

 1 month  2 months


Please detail the timetable of your stay (week by week)



5) Documents additionally requested:

 CV (2 pages max. included possible publications)*

 letter of support from your organization (written in French or English or with a translation in one of those languages)*

 letter of interest from your host organization (written in French or Englis)*


NB! Applicants should be 35 or less when applying!

Contact details :

Oksana Lando, Scholarship coordinator

French-Ukrainian center for scientific and university cooperation

Tel : + 380 44 504 01 39 / Fax : + 380 44 484 16 87 / Email : info@cfucus.org

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