CALL FOR APPLICATION FOR THE MEXICAN GOVERNMENT SCHOLARSHIP PROGRAM FOR FOREIGNERS 2011
APPLICATION FORM B
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APPLICANT’S GENERAL INFORMATION
Name: ____________________________________________________________________________________
First Name Last Name Middle Initial
Nationality:_________________________________________________________________________________
Gender: ( F ) ( M ) Birth date: _____/_____/_____
YYYY MM DD Marital status: Single ( ) Married ( ) Common law ( ) Divorced ( ) other (which one?) _____________________
Permanent home address: _____________________________________________________________________
Number Street District
____________________________________________________________________________________________
City/Town State/Province Country Zip Code
Phone (include country code): _________________________ Office telephone: _________________________ Email: ____________________________________________________________________________________
(*) The SRE may contact you officially by email.
STUDIES TO BE DONE IN MEXICO:
Title of the lecture, course, seminar, research or artistic intended to be done in Mexico: ______________________ ____________________________________________________________________________________________ Receiving Academic Institution: _________________________
Program start date: ___________________________ Program end date: ____________________________
Academic activity type for which the scholarship is being requested:
( ) Lecturer ( ) Researcher
( ) Visiting Professor ( ) Artistic Visit
( ) Mass Media Collaborator
ACCEPTED-ACADEMIC COORDINATOR, PROFESSOR OR ACCEPTED-ACADEMIC AUTHORITY YOU HAVE CONTACTED
Name: _____________________________________________________________________________________ Position: ______________________________________ Phone: ______________________________________ Email: _____________________________________________________________________________________ Indicate if you are already have been granted a scholarship to study or perform research for which you applied to the SRE Scholarship Program Yes ( ) No ( ) and if so, what is the granting institution and what is the term duration? ____________________________________________________________________________________
ACADEMIC DETAILS
Bachelor’s degree: ________________________________________ GPA: _______________________________ Institution: _____________________________________________ Start and end year ______________________ City and Country: ___________________________________
Master’s degree or medical specialty or subspecialty: _______________________________________________ Institution: _____________________________________________ Start and end year: _ __________________ GPA (mandatory): _______________________________ City and Country: ____________________________
Doctorate: _______________________________________________
Institution: _____________________________________________ Start and end year: _ __________________ GPA (mandatory): _______________________________ City and Country: ____________________________
Note: Indicate your GPA using a 0 to10 point scale.
Other degrees/qualifications culminating in the obtained academic degree. Please indicate institution name, city, country and dates of attendance. Attach evidence documents_______________________________________ ____________________________________________________________________________________________
LANGUAGES
First language: ___________________________________________________________________ Other languages: __________________________________________________________________
If the first language is not Spanish language, please indicate the Spanish language level you have and attach evidence document issued by any language center or university.
WORK EXPERIENCE
Are you currently employed? Yes ( ) No ( ) Institution or Company: ______________________________ Position:______________________ Years of working experience: ______________________________________
Previous Employment
Institution or Company: _____________________________ Position: _____________________________ Years of working experience: ______________________________________
TEACHING AND RESEARCH ACTIVITIES
Indicate the type of teaching or research activities you have performed, institution, teaching or research area and the corresponding period dates: __________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________
ACCEPTED-RECENT PUBLICATIONS
Indicate the title of the last three publications related to the activity you shall perform in Mexico (include dates): ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________
HONORS, AWARDS AND SCHOLARSHIPS/GRANTS
Honors, awards and academic distinctions you have achieved: __________________________________________ ____________________________________________________________________________________________
Abroad scholarships/grants. Please indicate the granting institution, country and dates when you took a postgraduate course or research degree: ___________________________________________________________ ____________________________________________________________________________________________
COMPLEMENTARY PERSONAL INFORMATION
Specify whether the spouse has been granted a scholarship/grant or has applied to the Scholarship/Grant Program in Mexico. Please include dates: __________________________________________________________________
Economic dependents information
Kinship Full Name Birth date Gender
In case the applicant already lives in Mexico, indicate:
a) Date of arrival into the country: ____________________________________________________________
b)
Home Address: ________________________________________________________________________Number/ Street District
_____________________________________________________________________________________
City State/Province Country Zip Code
Email: _______________________________________________________________________________
c)
Indicate what kind of visa you have and its expiry date: ________________________________________IN CASE OF EMERGENCY
Notify: _____________________________________________________________________________________ Kinship: ________________________________________________ Country: _____________________________ Phone (include country code):____________________________________________________________________ Fax: __________________________________ Email: _______________________________________________ Address: ___________________________________________________________________________________
ACCEPTED-IMPORTANT NOTICES
• In the case of visiting lecturers or professors, mention lecturer, seminar or course title that will be given. Attach invitation letter copy where dates and venue are established.
• If the scholarship is requested in order to carry out research within the framework of the “Genaro Estrada” Program for Specialist in Mexico (Mexicanist), the research project shall be submitted as part of this Application Form of Exhibit 1 “Applicable Standards of the Secretariat of Foreign Affairs to Foreign Grantees”.
• In addition, a 1 or 2 page letter shall be attached explaining the reasons for which the applicant is interested on carrying out research in Mexico.
• Original and complete applications as well as those submitted in time will be taken into account. Applications sent by email or fax will not be taken into account.
• The General Directorate for Educational and Cultural Cooperation is responsible of purchasing and managing the international air travel; therefore, any refund may be done in case the applicant or the receiving institution purchase directly the air travel.
• If the applicant cancels his/ her trip, once the air ticket has been issued by the SRE authorized travel agency, the receiving institution or the applicant will be requested to pay the flight ticket if it is not refundable.
• If the economy class fare ticket implies a stop or connection in any USA city, the applicant shall assured the accreditation and validity of the corresponding visa
ACCEPTANCE
I accept the conditions of the Call for Application for the Mexican Government Scholarship Program for Foreigners 2011, a part of which comprises the document entitled “Rules applicable to grantees of SRE scholarships for foreigners.”
______________________________________ ____________________________
Applicant’s signature Place and Date
CALL FOR APPLICATION FOR THE MEXICAN GOVERNMENT SCHOLARSHIP PROGRAM
FOR FOREIGNERS 2011
Documents which must accompany Application Form B
1.
Use Application form B of this Call (*), corresponding to the year when the activity will be
performed, properly filled in Spanish language, handwritten signed by the applicant and
accompanied by a photograph..
2.
Letter of acceptance from the receiving Mexican academic institution addressed to the
General Director for Educational and Cultural Cooperation of the SRE mentioning the
special program for which the scholarship is requested and clearly indicating the Lecture,
Research, Professorship or Artistic Work title, according to the case, that the foreign
citizen will perform as well as activity starting and ending dates.
3.
If the candidature is submitted through our diplomatic or consular representation in the
applicant’s country of origin, the invitation letter of the Mexican institution shall be
attached.
4.
