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Visiting Faculty Program - Application Form

Application Form

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 ____________ , _____________  

                                                                                                                                     months                      year

(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 ___________________________________

 

Please attach:

  • 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: visiting.proposal@weizmann.ac.il

     

All applications must be received annually no later than March 31 or September 30.