中国科学院外籍青年科学家交流计划管理细则

编号：中国科学院外籍青年科学家计划推荐表CASYoungscientistsfellowship推荐单位名称（盖章） 外籍青年姓名 外籍青年国别申请来华期限Duration中国科学院国际合作局制年月日

外国青年科学家的基本情况姓名Name性别Gender国籍Nationality职位Title电话TelE-Mail传真Fax研究领域(中英文)ResearchField(CH/EN)工作单位(中英文)Workplace(CH/EN)联系地址Contactaddress

外国科学家简历、主要学术和技术成就、在国外机构和国际组织任职情况以及曾获得的主要国际学术奖(中英文)Resume,academicachievements,awards,internationalorganizationactivitiesetc.(bothinChineseandEnglish)外国青年科学家在我院工作计戈IJ安排外国科学家在我院期间的具体合作研究项目、学术交流、人才培养、拟解决问题等活动计划Resume,academicachievements,awards,internationalorganizationactivitiesetc.(bothinChineseandEnglish)依托单位合作者的情况以及推荐意见联系人员信息姓名HostPI性别Gender职务Title电 话TelE-Mail手机Cellphone传真Fax

研究领域（中英文）ResearchfielddescriptionofhostPI(Ch/En)推荐单位意见以及相关承诺推荐单位负责人： （盖章） 年月日专业局意见专业局领导： （盖章） 年月日国际合作局的意见国际合作局领导： （盖章） 年月日国际合作主管院领导意见主管院领导： 年月日

CHINESEACADEMYOFSCIENCES

APPLICATIONFORFELLOWSHIPFORYOUNG

INTERNATIONALSCIENTISTS1.NameinFullFamily First Middle2.Gender□Male□Female3.DateofBirthDDayMonthYear4.Nationality5.Citizenship6.PermanentResident7.CurrentAppointmentand/orStatusTitle:Division:Institution:8.AcademicDegree(Ph.D.)Type: DateObtained(orExpected)Field: / /Institute: Country: DayMonthYear9.HigherEducation(Startfromthelatestone)NameofUniversity/Institution Location Degree Field CompletionDate(Month/Year)10.PreviousEmployment(Startfromthelatestone)NameofInstitution Location Position From-to(Month/Year)11.AcademicAwards(Pleaseindicatetitle,yearandconferrer.)12.ResearchFieldandSpecialization13.NameofProposedHostResearcherandHostInstitutionHostResearcher:Title:Division:HostInstitution:ResearchThemeinCAS(upto100lettersincludingspacesandsymbols)ProposedTenureofCASYoungFellowshipFrom: / / to / / Total:DayMonthYear DayMonthYear MonthsResearchPlaninCAS:Pleaseincludeatleastthefollowingitems:PresentresearchrelevanttoproposedresearchplanPurposeofproposedresearchProposedPlanExpectedresultsandimpacts

19.LanguageAbility(5:excellent 1:poor)SpeakingReadingWritingHearingEnglish54321 54321 543215432154321 54321 543215432154321 54321 543215432154321 54321 5432154321Chinese54321 54321 5432154321PastStay(s)inCASPlace: Year: Purpose:Name(s)ofotherfellowship(s)forwhichyouarenowapplyingMailingAddress(Approximatelythreemonthsafterreceivinganapplication,CASwillsendoutfellowship-commencementdocuments,socareshouldbetakentoensurethattheaddresswillremainvalid.PleasecheckOfficeorHome;unlessotherwisestatedwewillsendthedocumentstoyourOffice.□Office: □Home:Tel:Tel:Fax:Fax:E-mail:E-mail:23.Willyoubeaccompaniedbyspouseand/oroffspring(s)?Ifso,pleaseindicatetheirnamesandrelationship.Name:Relationship:24.IfyouhavebeenpreviouslyawardedasaCASfellowshiporparticipatedinanotherCASresearchprogram,pleaseindicatethenameoftheprogramandtheperiodofyourparti