Application Form

Alfred Vogt-Scholarship

17%

1) Personal information

2) Project/thesis

1) Personal information

Surname

First name

Date of Birth (dd/mm/yyyy)

Date

Place of birth (Place, Country)

Nationality

(For Foreign Nationals) Residency in Switzerland since

Civil status

Children (no.)

Children ages

Profession and academic title

Private address (Street, No., Postcode, Place, Country)

Future address (in case of imminent move in the near future) (Street, No., Postcode, Place, Country)

Telephone number (mobile)

Telephone number (work, others)

E-mail address (private)

E-mail address (work)

Place of work (Clinic/Institution, Street, No., Postcode, Place, Country)

2) Project/thesis

Research title

Description (min. 5,000, max. 10,000 characters)

10000 characters left

In case of project for habilitation thesis: which faculty will you submit thesis to

3) Scholarship

Start of the scholarship

Datum

End of the scholarship

Datum

4) Financing

For the same purpose received or assured contributions from funds, foundations etc. (Name of donor, value in CHF)

Pending or intended other applications for contributions (Name of donor, value in CHF)

Income of the applicant (CHF/year)

Income of spouse (CHF/year)

Budget (research costs, fees, field expenses, travelling expenses, etc.)

References

5) Uploads

Hint for all uploads: max. 25MB (per File), allowed file types: PDF, MS-Office, Google-Office, Images and Videos

Research Project (.pdf)

Additional Documents

6) Submit

Policy

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Application for Alfred Vogt-Scholarship

Alfred Vogt-Scholarship