ANNEX A GRANT APPLICATION FORM The Grant Application Form consists of two parts, labelled: Part 1 : Administrative information (MS Excel format) Part 2: Complementary information and description of the research project (MS Word format) It is a necessary condition for further evaluation that both Part 1 and Part 2 of the application form be duly completed and submitted. Incomplete application may not be considered for further selection. Applications must be submitted in one original and four copies. ##### Sheet 2 ##### Application Form - Part1 Administrative information SCIENCE & TECHNOLOGY FELLOWSHIP PROGRAMME CHINA Please submit one original and four copies of this form All data given in this form will neither be used for commercial purposes nor given to any third party. All data submitted are for STF CHINA internal use only. Basic Profile 1. Full NaFamily Name Middle Initials Given Name 2. Nationality 3. Marital Status 4. Date of Birth 5. Sex 6. Passport Number 7. Expiry Date of Passport 8. Place of Birth (as written in the passport) 9. Interests and Hobbies 10. Current China Visa Typ11. Expiry Date of Current Visa 12. CurrenCountry City Personal Contacts 13. PostalAddress Post Code 14. Phone Country code City/area code Phone number 15. Mobile phone number 16. Phone Country code City/area code Phone number 17. Fax (oCountry code City/area code Phone number 18. Personal E-mail ( important information will be sent your email box) Emergency Contacts 19. Contac Name Phone Fax 20. Contac Name Phone Fax Language Skills 21. LanguaMother tongue Reading SpeakingListenin Writing English Chinese Education 22. Highest Education 23. Graduate School/University Work Experience 24. Total length omonths 25. Total length omonths Sending Institution Profile 26. Full Name of organisation 27. STF CHINA will provide financial support such as international travel and monthly allowance. Will your organisation cov Sending Institution Contacts 28. AddresAddress Post Code 29. TelephCountry code City/area code Phone number 30. Fax ofCountry code City/area code Phone number 31. E – mail of organisation 32. Website of organisation (if available) Proposed research in China 33. Short summary of your proposal Information of Practical Research in a Chinese host institution 34. Have you secured a Chinese hosting institution? 35. Name of Host Organisation 36. Town/city 37. Postal Address 38. Post Code 39. Phone 40. Fax 41. E-mail 42. Contact person 43. Position of contact person 44. Website of the organisation Other Information 45. How did you learn about STF CHINA? Please note that the Application Form is complete only when this part 1 is submitted together with Part 2 ##### Sheet 3 ##### APPID APPDATEIDNumbeFullnamLastNamMiddleIFirstNaFullNamFirstNaLastNamBirthDaSex NationaProvincAddrCouAddrProAddrCitAddrPosAddrStrAddrHomHomePhoHomePhoHomePhoMobile OfficePOfficePOfficePEmail Group12Edu1SchEdu1DepEdu1GraEdu1DegEdu2Sch 54 2006-113206827DAN XiDAN N/A Xiaohon??? N/A ??? 1977-6-Male China ZhejianChina ZhejianNingbo 315221 303 rooN/A +86 0574 8630596+86-133+86 0574 86305pupusxhChineseCenter ResearcN/A Master Center Edu2DepEdu2GraEdu2DegEdu3SchEdu3DepEdu3GraEdu3DegENGLeveENGCertCurrentDuty1 Duty2 Duty3 Duty4 Duty5 JobDateJobDateEmployLWork1PeWork1CoWork1PoWork1TaWork2PeWork2CoWork2PoWork2TaWork3PeWork3CoWork3PoWork3TaCompanyCompanyCompanyCompany ResearcN/A BacheloN/A N/A N/A N/A level 5CET-6 QA/QC dTo seleTo prepTo founTo manaTo inve2005-10Now 2 yearsN/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Neorem ????????? ?? CompanyCompanyCompanyCompanyCompanyBusinesProductAnnualTCompanyYourEmpAPPStatIntakes ?? 315221 ???????N/A OctoberProductApplica200000040 20 0 1 ##### Sheet 4 ##### APPID APPDATEIDNumbeFullnamWhereMEENSkillCnskillADDLAN1ADDLAN2ADDLAN3FurEduPFurEduYFurEduCFurEduMFurEduCFurEduPFurEduYFurEduCFurEduMFurEduCFurEduPFurEduYFurEduCFurEduMFurEduCFurEduPFurEduYFurEduCFurEduMFurEduCWorkExpWorkExpWorkExpWorkExp 54 2007-1-N/A N/A businesexcelle0 No 0 0 Oral En2005.12China 5 No Product2004.12China 1 No 0 0 0 0 0 0 0 0 0 0 Sany Gr12-36 mjunior Materia WorkExpWorkExpWorkExpWorkExpWorkExpWorkExpWorkExpWorkExpWorkExpWorkExpWorkExpWorkTotWorkTotWorkTotTotInteTotWorkComNameComFaxCComFaxRComFaxNComEmaiComWeb ComCEONComCEOEComJun ComMid ComSen ComDepaDepartPDepartPComSuppComSuppComSuppComSect China Neorem 12-36 mmiddle QualityChina 0 0 0 0 0 12-36 mmore th29 0 29 Neorem +86 0574 8630592eva.zhowww.neo??? eva.zho1-5 1-5 1-5 1-5 Other Qualityoperatimanagerother Other m ComProDComProdComProdComProdComProdComProdComTurnComExport 0 permaneMagnetiPlating0 0 1-5 20%-50% ##### Sheet 5 ##### APPID APPDATEIDNumbeFullnamPartNamPartProPartAddPartPhoPartEmaPartConPartConPartWebPartBusPartBusPartEmpPartTurPartExpPartCoTPartCoRInternNInterPrInternAInternPInternEInternCInternCInternWYComEmpYDepartToTEnteEnterTeEnterTeEnterTeEnterBu 54 2007-1-N/A N/A No FinlandNo No dan.shaNo No 0 Other m0 data nonot avaChineseintendenone 0 0 0 0 0 0 0 0 50 - 10more th1-36 mo+86 0574 8630592N/A EnterBuEnterBuEnterPrEnterPDEnterSeEnterSePartRecBusiPlaPerStatOtherDocs N/A N/A N/A N/A Han 0 0 BusinesN/A N/A ##### Sheet 6 ##### IDNumberFullnameLastNameMiddleInitiFirstNamFullNameFirstNamLastNameBirthDate Sex NationalMarital BirthPlaReligionHobbies ChinaVisVisaDate PassportDate ResidencResidencAddrHomePostCodeHomePhonHomePhonHomePhonMobile OfficePhOfficePh 1900/1/0 #REF! 1/0/1900 1/0/1900 #REF! OfficePhFaxCountFaxCity FaxNumbeEmail ContactCContactCContactCContactEContactEContactEENGLevelENGLevelENGLevelENGLevelCHNLevelCHNLevelCHNLevelCHNLevelHSKExam HSKScoreSecondLaSecondLeThirdLanThirdLevEducatioSchool EmployMoWorkMontCompanyN #REF! #REF! #REF! #REF! #REF! #REF! 0 0 CompanySSectorOtCompanySCompanyACompanyPCompanyTCompanyTCompanyTCompanyFCompanyFCompanyFComEmailComWeb InternYEInternOrInternOrInternSeInternCoInternAdInternPoInternPhInternFaInternEmInternCoInternCoInternWeInternStart InternEndGroup #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! WhereMETP ##### Sheet 7 ##### IDNumberFullnameLastNameMiddleInitiFirstNamFullNameFirstNamLastNameInternOrInternOrInternSeInternCoInternAdInternPoInternPhInternFaInternEmInternCoInternCoInternWeInternStInternEnGroup WhereMETP #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! ##### Sheet 8 ##### Anhui Chinese Managers from SMEs 1-12 monless than 24 months Male China Beijing Chinese Managers from Public Sector 12-36 momore than 24 months Female Austria Chongqing Chinese Managers from Media Sector 36-60 months Belgium Fujian Chinese Managers from NGOs more than 60 months Yes Bulgaria Gansu European Managers from SMEs or Non-Profit Organizations No Cyprus Guangdong European Entrepreneurial Participants employee Czech Republic Guangxi junior management Denmark Guizhou middle management Estonia Hainan level 1 - basic senior management Finland Hebei level 2 other France Heilongjiang level 3 0 Germany Henan level 4 1-5 1-5 0-1 0-1% less than 10 none none Greece Hubei level 5 - excellent 5-10 5-10 1-5 1%-5% 10-50 1-5 1-2 Hungary Hunan 10-20 more than 10 5-10 5%-10% 50 - 100 5-10 2-5 Ireland Jiangsu more than 20 10-20 10%-20% 100 -500 10-20 5-10 Italy Jiangxi 20-50 20%-50% more than 500 more tha10-20 Latvia Jilin from my company/institution/organisation, i.e. director, HR department, etc. more thamore thadata not available or un20-50 Lithuania Chongqing promotion campaign General Management not available or unknown more than 50 Luxembourg Liaoning business associations (e.g. chamber of commerce, etc.) Sales and Marketing Malta Inner Mongolia internet Financial Management/Accounting Poland Qinghai advertisement Manufacturing & Production Portugal Ningxia The EU-China Managers Association, EUCMA Human Resource Romania Shaanxi recommended by friend or colleague Journalist IT Department Slovakia Shandong other Other Research Slovenia Shanghai Sales Spain Shanxi Logistics Sweden Sihuan Other The Netherlands Tianjin poor BeginninTOEFL none ????????? (Bălgarski) - BG - Bulgarian United Kingdom Xinjiang basic Fair IELTS 0-6 months Čeština - CS - Cnone Chinese markets intendednone Tibet satisfacGood NONE 6-12 months Dansk - DA - Danfinancial support European marketsless tha1-36 months Yunnan good Excellent 12-24 months Deutsch - DE - Goperational or technicalGlobal presence 1-3 yearmore than 36 months Zhejiang excellent more than 24 monEesti - ET - Estmanagerial support unknown 3-5 years Other native speaker Chinese native sElinika - EL - Gcareer / internal promotion more than 5 years English - EN other Agriculture, forestry, finone none none Espa?ol - ES - Spanish Mining and quarrying regular regular contactsregularly business contaHan Français - FR - French Food and Beverages co-operaco-operation protrade relationship Other Gaeilge - GA - Irish Textiles and leather proddevelopmother joint development and investment projectItaliano - IT - Italian Publishing, printing, repjoint development/investproduction Latviesu valoda - LV - Latvian Chemicals, chemical produother Lietuviu kalba - LT - Lithuanian Computers and electronic products Magyar - HU - Hungarian Electrical Equipment Malti - MT - Maltese Motor vehicles or other tTransport Nederlands - NL - Dutch Recycling, environmental Personnel Department/HumChinese society Polski - PL - Polish Other manufacturing Finance and Statistics European society Portugu?s - PT - Portuguese Electricity, gas and wateEducation Global presence Română - RO - Romanian Construction Public Relations Slovenčina - SK - Slovak Whole sale and trade Public services Slovenščina - SL - Slovene Hotels, restaurant Industry Suomi - FI - Finnish Logistics, transport and Commerce / Trade Svenska - SV - Swedish Financial and insurance sConstruction and Maintenance Real Estate, rental and lPublic security / Civil affairs No Degree Research Politics and Law TV Bachelor Education Science and Technology Radio Master Health Women Status Newspaper Doctor Social work Environment, natural resFilms/Movies Post Doctor Tourism Culture (art, history) Publications Other Tourism Magazines Social welfare / social Advertisement Single Labour Internet Married Sports activities Photography Public health and Other Children and Youth CCPIT and its network Communication Communist party Conflict resolution, disaOther Disaster relief Drug Abuse Education Environment Ethics and Values Human Resource Human Rights Family, health and nutrition Natural resource and energy Peace and security Population and human settlements Science and technology Sustainable Development Trade Finance Transport Women Status Sports activities Other