Please print this form and complete it by hand. Alternatively, open and complete the Word application form.
Family Name ________________________ Given Name ________________Middle Initial __________
Passport number (or ID number if Israeli citizen) _____________________________________________
Rank _________________________. If not Assistant/Associate Prof., Please specify ________________
Present Place of Employment ___________________________________________________________
Address of Present Place of Employment __________________________________________________
Ph.D. or equivalent awarding Institution ___________________________________________________
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 ____________ , _____________
(Please note that if the duration of the requested visit is more than three months total support from the
Visiting Faculty Program will not exceed three months).
Have you in the past been awarded a Weizmann Visiting Fellowship? __________. If yes - Please specify:
Period/s of the Visiting Fellowship _______________________________________________________
Past Visits to Weizmann Institute of Science (if any) please detail year/s and duration (in months):
Signature ___________________________________ Date ___________________________________
- 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
Endorsement (by signature herein) of request by:
- Head of proposed hosting department: 1
- Dean of proposed hosting Faculty: 2
1,2 In place of signature you may attach an e-mail affirming endorsement of this application from the above-mentioned.
Please submit the completed application by e-mail to: email@example.com
All applications must be received annually no later than March 31 or September 30.