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                                                                             IDC_English_Blue

                                            APPLICATION
                                                FOR
                                MASARYK DISTINGUISHED CHAIR PROGRAM

                                             Call 2014
                                     Deadline: 15 October 2014

1.        APPLICANT INFORMATION

Title


First name


Family name


Date of birth


Country of citizenship


Private address



Telephone


E-mail



2.        PROFESSIONAL PROFILE

Home institution in the Czech Republic



Mailing address



Current academic/professional position and starting date in that position


Major academic discipline



Other specialization(s)



Foreign language competence





Most significant professional accomplishments

Include items such as significant teaching and research awards, papers delivered at conferences
etc.




Lecturing activity

Summarize your teaching experience and pedagogical approach, indicate your participation in
teaching/curriculum projects etc.




Research activity

Summarize your research background and publication activity, indicate your research grants etc.




Professional trips abroad of over 3 months during the past 10 years

Include the country, purpose and length of your stay





3.        PROJECT DETAILS

Project title


Key words

List 5 keywords that best describe your proposed research activity


Proposed length of stay

(Min. Length = 2 weeks, max. Length = 3 months)


Proposed dates of stay

1^st choice:

2^nd choice:



Time flexibility

Please state how flexible you are concerning dates of your stay


Lecturing activity at IDC

Are you interested in giving lectures during your stay at IDC? Please specify the relevant subject
areas.


Project description

Provide a detailed outline of the research project. Define measurable goals and outputs of your
project. Min. 4000 and max. 8000 characters.

















4.        PROJECT IMPACT

Describe the expected impact of the proposed project on your professional competences, including
teaching/research activities and benefits for your home and host institution.








5.        ACADEMIC TUTOR IN ISRAEL

Title


First name


Family name


Instituiton


Position


Telephone


E-mail



6.        ATTACHMENTS

All applicants are required to submit:

a)      Curriculum vitae

b)      Confirmation – either a letter or e-mail from the academic tutor agreeing to support
planned academic activity in Israel

c)       Selected bibliography

d)      Course outlines or syllabi (in a single combined document, only for projects including
lecturing activity – by email only)

e)      References

All attachments must be provided in English.

7.        SIGNATURE

I, the undersigned, certify that the information contained in this Application Form is correct to
the best of my knowledge.


Place:


Date:

Name:



Signature: