IIAS Fellowship Application Form

1. Applicant details
Surname
First name(s) Sex: M/F

Title of research project

To which cluster does your [ ] Asian Cities
research relate? [ ] Asian Heritages
[ ] Global Asia
[ ] Open category

Permanent home address*

City
Country
Telephone
Fax
E-mail
Institutional address*
City
Country
Telephone
Fax
E-mail
* Address for correspondence is: A) my home address B) my institutional address

Date of birth
Place of birth
Nationality
Profession
PhD obtained on (date, topic and
title)
2. Requested start date of the fellowship : ____ ____ ______ (dd-mm-yyyy)
(Please take into account that if you must apply for a visa, this can take several months).

3. Duration of the fellowship

How many months would you like to stay?

[ ] Not self-funded .. months (please indicate a time period from 1 to 10

months).

[ ] Self-funded weeks/months (maximum 10 months).

Means of funding:
[ ] A) Existing salary;
[ ] B) Other(s), please specify:

If self-funded: enclose official letter(s) indicating funding source, and, in case of a fellowship
of 3 months or more, please provide details on the amount.

If partly self-funded: please indicate the specific circumstances below (intended duration of
stay in Leiden; funds available; funds required from IIAS):

4. Have you tried to apply for funds from other organisations?

5. Description of research project (max. 1000 words) and
timetable:

6. Expected output (e.g. publications, conferences, collaborative grant

proposal, etc.)

7. Reason for undertaking research in the Netherlands (max. 250

words)

8. Have you already established contacts in the Netherlands?

9. References
Name Position
10. Is this the first time you have applied for an IIAS fellowship?

[ ] Yes

[ ] No, please give date of any previous application:

11. How did you come to know about the IIAS fellowship?

[ ] IIAS Newsletter

[ ] Website

[ ] Other: ..

When completed, return this form with all required information to:

International Institute for Asian Studies

Visiting address: Postal address:

Rapenburg 59 P.O. Box 9500
2311GJ Leiden 2300 RA Leiden
the Netherlands the Netherlands

T +31-71-527 2227
F +31-71-527 4162
E iiasfellowships@iias.nl

Please make sure all the required information (where applicable) is enclosed

CV & a separate list of publications

Letters from at least two referees
Official letter(s) of funding (self-funded applicants only)