1
SECTION 1
SECTION 2
Name (block capitals):
Sur
name: Forenames
:
1
Application for consideration
as a research scholar
T
itle: (Dr, Mr, Mrs, Ms, other)
2
Marital Status:
5
Date of Bir
th:
3
Nationality:
(a) Cur
rent (b) Previous
4
Proposed Dates of Visit to the School
From: To:
6
Field(s) in which research is to be carried out (if a particular research project is involved, please specify)
7
If you wish to attend specific lecture courses or seminars, please indicate which (or what kind) you have in mind
8
This for
m, when completed, should be returned to: The Departmental Manager,
(Depar
tment which you are applying to)
,
London School of Economics and Political Science, Houghton Street, London WC2A 2AE, England.
2
SECTION 3
Academic Qualifications
Name of University/College and countr
y Dates attended
(eg 2001-2004)
T
itle of academic qualifications awarded and
class eg Economics BA(Hons) 2:1 JD with GPA3.7
or in the standar
d format for your academic
qualification
9
Principal/major subject taken eg Economics,
Accounting. Date awar
ded (DD/MM/YY)
Pr
esent Employment
Dates fr
om and to
Nature of work and position held
10
Name and addr
ess of employer
Pr
evious Employment (Most recent first)
Dates fr
om and to
Natur
e of work and position held
Name and addr
ess of employer
Publications
Please give titles, publishers and place and date of publication.
11
3
SECTION 4
SECTION 3 (Continued)
SECTION 5
Are there any members of academic staff at the School with whom you particularly wish to make contact?
13
Would you be in receipt of any research grant or study/travel award during your stay at the School? If so, please name it and indicate what type of award
it is (you need not give financial details).
15
SECTION 6
Please use this space (or the continuation sheet on the last page) if you wish to add any further information in support of your application.
17
Is this application conditional upon any such awar
d being made?
16
Please give the names and addr
esses of two persons who could act as academic referees if required.
14
Cur
rent Research Interests
Please indicate any cur
rent or recent research interests not already mentioned.
12
4
SECTION 6 (CONTINUATION SHEET)
Permanent Address: Address in Britain (If known)
SECTION 7
Signature:
18
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