Academic Year October 2014 - September 2015
Application form as MS Word version
Family Name ________________________ Given Name _________________Middle Initial ___________
Passport number (or ID number if Israeli citizen) ________________________________________________
Rank __________________________ . If not Full Professor, Please specify _________________________
Present Place of Employment _________________________________________________________
Address of Present Place of Employment ________________________________________________
Fax Number __________________________ E-mail Address _______________________________
Home Page _______________________________________________________________________
Citizenship: Israeli/non Israeli (erase and complete as relevant)________________________________
Date and Place of Birth _____________________________________________________________
Marital Status _____________________ Number of Children (who will accompany you) __________
Proposed Field of Research ___________________________________________________________
_________________________________________________________________________________
Approximate duration of proposed visit _________ months from __________ , ___________
months year Have you in the past been awarded a Weizmann Visiting Professorship? __________. If yes - Please specify:
Name of Visiting Professorship ____________________________________ Period/s of the Visiting
Professorship ____________________________________________________________________Signature _________________________________ Date __________________________________
Please attach:
Endorsement (by signature herein) of request by:
- your curriculum vitae
- a list of your publications
- a brief statement of your proposed research (1-2 pages)
- your photograph
- letter of invitation from your prospective host at the Weizmann Institute
1,2 In place of signature you may attach an e-mail affirming endorsement of this application from the above mentioned.
- Head of proposed hosting department: 1
- Dean of proposed hosting Faculty: 2
Please submit the completed application by e-mail to: visiting.proposal@weizmann.ac.il
All Applications Must Be Received annually No Later Than December 31
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