International atomic energy agency (iaea) wagramer strasse 5, P. O. Box 100, a-1400 vienna (austria) icon

International atomic energy agency (iaea) wagramer strasse 5, P. O. Box 100, a-1400 vienna (austria)



НазваниеInternational atomic energy agency (iaea) wagramer strasse 5, P. O. Box 100, a-1400 vienna (austria)
Дата конвертации14.05.2013
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ТипДокументы
источник
1. /form for fellowship.doc
2. /form for scientific visit.doc
3. /form for training course.doc
4. /form for workshop-meeting.doc
International atomic energy agency (iaea) wagramer strasse 5, P. O. Box 100, a-1400 vienna (austria)
International atomic energy agency (iaea) wagramer strasse 5, P. O. Box 100, a-1400 vienna (austria)
International atomic energy agency (iaea)
International atomic energy agency (iaea)






INTERNATIONAL ATOMIC ENERGY AGENCY (IAEA)

WAGRAMER STRASSE 5, P.O. Box 100, A-1400 VIENNA (AUSTRIA)

TELEPHONE (+43 1) 2600, FACSIMILE: (+43 1) 26007

E-MAIL: Official.Mail@iaea.org, TC WEB SITE: http://www-tc.iaea.org






FELLOWSHIP APPLICATION

Note: This form cannot be used to apply for a training course or for a scientific visit.


INSTRUCTIONS


PLEASE READ CAREFULLY


The IAEA requires two completed copies of this form for each applicant nominated. Please type or print in ink.


Section A (1-10): To be completed by the applicant and supervisor.

Section A (11): To be completed by the designated certifying official of the nominating Government.

Section B: To be completed by the Government official responsible for atomic energy matters in the country concerned.

Section C: To be completed by a registered medical practitioner.

Section D: To be completed by a qualified language teacher.


Paragraph 6 and 8 from section A should be completed in English. If a visit to a French or Spanish-speaking host country is requested, an additional translation in the respective language should be provided by the applicant.


A complete transcript of the academic record is required for each applicant, including the following information about undergraduate or post-graduate courses:

  • Number of semesters or academic years of study:

  • Subjects studies in each semester or academic year;

  • Grade (such as fair, good, very good, excellent or any other code system) for each of the above mentioned subjects; and

  • Degree obtained upon graduation.


A certified translation of this transcript is required if it is issued in a language other than that of the requested training programme.


BEFORE SIGNING, PLEASE BE SURE THAT ALL QUESTIONS HAVE BEEN ANSWERED. COMPLETE FORMS CAN BE PROCESSED MORE RAPIDLY THAN INCOMPLETE ONES.


The IAEA application forms for fellowships must be submitted to the Agency

through governmental channels

and priority is given to requests associated with projects of direct benefit to the Member States.

The IAEA may consider your requirements are better met by a scientific visit. To qualify for a scientific visit, the candidate must have worked for at least five years in the field in which the visit is requested, and should hold an appropriate advisory or management position; the duration of the visit should be up to a maximum of four weeks, with not more than two weeks at any one institute





INTERNATIONAL ATOMIC ENERGY AGENCY (IAEA)

WAGRAMER STRASSE 5, P.O. Box 100, A-1400 VIENNA (AUSTRIA)

TELEPHONE (+43 1) 2600, FACSIMILE: (+43 1) 26007

E-MAIL: Official.Mail@iaea.org, TC WEB SITE: http://www-tc.iaea.org






A
Page

FELLOWSHIP APPLICATION

Note: This form cannot be used to apply for a training course or for a scientific visit.


If the proposed training is project related, give IAEA project code: INT/ 0/ 081

and title: 2008 WNU Summer Institute 

  1. PERSONAL DATA













 Female  Male




Date of birth:







Family name:




Place of birth:







(as in Passport)




Nationality:

Recent




First name:




Passport No.:

photograph




Complete mailing address (office):




Date of issue:

of candidate




Inst. Name:




Place of issue:













Valid until:







Street:




Telephone (office):







P.O. Box:      

Post Code:




Telephone (home):







Town/City:




Fax:




Region/District:




E-mail:




Country:




Web Page:




Airport/town nearest to residence:




Emergency Phone no.:







  1. PRIVATE ADDRESS

  1. EDUCATION (commencing with secondary school)




Years attended

Name and place of institution

Field of study & Diploma/degree

from

to



















  1. KNOWLEDGE OF LANGUAGES

Read

Write

Speak

Understand


Mother tongue: russian

Other languages

Good

Ave-
rage

Not easily

Good

Ave-
rage

Not Easily

Good

Ave-
rage

Not Easily

Good

Ave-
rage

Not Easily







    

    




    

    




    

    




    

    

     

    

    

    

    

    

    

    

    

    

    

    

    

     

    

    

    

    

    

    

    

    

    

    

    

    

  1. RECENT EMPLOYMENT RECORD

Years of service

Name and place of

Title of position

Type of work

from

to

employer/organization





































     

     

     

     

     




  1. DESCRIPTION OF WORK

Describe in detail (in 200 words) the work you have been doing during the past 3 years (Please attach list of any material you may have published)


  1. P
    A

    Page 2
    REVIOUS PARTICIPATION IN AN IAEA ACTIVITY


Have you participated in a previous IAEA activity? If yes, please list each activity below:



  1. PRIMARY OBJECTIVES TO BE ACHIEVED BY THE PROPOSED TRAINING

  1. Outline in at least 200 words the detailed programme of training you require:




  1. Outline in at least 200 words the detailed programme of work you expect to carry out during the next 12 months at your home institute before starting the training you requested:




  1. If the fellowship is linked to a Technical Cooperation Project, outline in at least 200 words the roles foreseen by the supervisor or project counterpart upon the applicant’s return, and how the training will be of value to meeting the needs of the project objectives:




  1. HOST COUNTRY(IES)

  1. Indicate the countries where you would like to be trained. The Agency reserves the right to select the appropriate country of training.

Canada


  1. If you are acquainted with the proposed host country or countries, list the institution where you desire training to be arranged. If known, indicate also the names of the individual(s) under whose direction you would like to work.




  1. Indicate how much time you could devote to the training, and the period when you would be available to undertake the training (please keep in mind it may take several months from submission of application to finalise arrangements). Indicate any period when you would not be available.






A

Page



  1. I hereby certify that the statements made by me in this application are true and complete. If selected for a fellowship, I undertake to:

  1. Conduct myself at all times in a manner compatible with my status as a recipient of an IAEA training award;

  2. Spend the full time during the period of the award in the training programme as directed by the supervising agency in the country of study and by the IAEA;

  3. Refrain from engaging in political and commercial activities;

  4. Submit reports in accordance with the requirements of the IAEA;

  5. Return to my home country at the end of the fellowship and work in my country for a period of at least two years in the field of peaceful uses of atomic energy;

  6. Accept no remuneration other than the fellowship stipend and the salary which is paid to me by my own Government or Institution nor render any services against payment or other form of remuneration;

  7. Inform the IAEA whenever there are changes in my status or availability that will affect the terms of my IAEA training award.


BEFORE SIGNING PLEASE BE SURE THAT ALL QUESTIONS HAVE BEEN ANSWERED


     
Date Signature of applicant


     

Date Signature of supervisor




  1. The Government of

is cognizant of the principles and rules pertaining to IAEA-supported training awards and nominates the applicant (family and first name(s)):

for a fellowship in (specify topics):

and, noting the responses given by the applicant to the questions above, gives assurance that:

  1. All information supplied by the applicant is complete and correct;

  2. After completion of the training period, the applicant will be offered a suitable position in order to permit him/her to work in his/her country for a period of at least two years in the field of peaceful uses of atomic energy;

  3. In case the applicant is already employed, his/her salary will continue to be paid throughout the period of the award;

  4. The applicant will be paid all expenses relating to his/her passport, visa, medical examination and other incidental expenses;

  5. All medical costs not covered by insurance which are incurred during the fellowship due to illness or injury will be met by the Government;

  6. No facts are known to the Government regarding the reliability and character of the applicant which would obstruct giving him/her access to nuclear installations or institutions where ionizing radiation is used.



     
Date Signature of certifying Government official


     

Name and title of official (typed or printed)





B

STATEMENT BY THE GOVERNMENT OFFICIAL RESPONSIBLE FOR
ATOMIC ENERGY MATTERS IN THE COUNTRY



If the proposed training is project related, give IAEA project code: INT/ 0/ 081

and title: 2008 WNU Summer Institute

Name of the applicant (family name and first name(s)):


  1. What are the objectives of this proposed fellowship from the Government’s point of view?




  1. Explain how the applicant’s training programme will achieve the above objectives.




  1. Explain clearly and fully how the experience gained by the applicant on his/her fellowship will be utilized on his/her return home to further the peaceful uses of atomic energy in the country, either with the organization responsible for atomic energy matters or with another national or private-sector institution.




  1. Priority will be given to fellowship applications which are related to projects. If this application is related to an Agency, a UNDP or a locally-supported project, please identify the project (by project code, if possible) and give details relating the aims of the fellowship in relation to the project activities.



     

Date Signature of Government official responsible for atomic energy matters in the country


     

Name and title of official (typed or printed)






C
MEDICAL REPORT


INSTRUCTION: To be completed in duplicate by a registered medical practitioner after a thorough clinical and laboratory examination including an X-ray of the chest. The International Atomic Energy Agency reserves the right to require the applicant to undergo a further medical examination before he/she takes up his/her fellowship.



Name of applicant:


Date of birth (year-month-day)  Female  Male Height (cm): Weight (kg):

  1. List any abnormalities which are indicated by the chest X-ray:




  1. If the applicant has been under treatment during the last three years, please describe the condition, the treatment and the present status of the disease(s):




  1. List all medications which the applicant regularly takes; explain the reason for each:




  1. What is the applicant’s normal blood pressure?




  1. Is the applicant in good health and able to work at full capacity?




  1. Is the applicant able physically and mentally to carry on intensive training away from his/her home?




  1. Is the applicant free from infectious diseases (for example tuberculosis or trachoma) which could present risks for both the applicant and his/her contact during his/her period of training?




  1. Does the applicant have any medical condition which might require treatment during his/her period of training?




Full name and address of examining physician (printed or typed)

     


     

Date Signature and stamp of the examining physician




L
D
ANGUAGE CERITIFICATE FOR FELLOWSHIP APPLICANTS


CERTIFICATE OF KNOWLEDGE OF ENGLISH, FRENCH or SPANISH (as applicable)

Name of the applicant:

Address of the applicant:

Type of test administered:      

Overall score obtained:      

Please mark appropriate boxes in sections (1), (2), (3), (4) and (5) below:

(1)

ABILITY TO UNDERSTAND









Understands without difficulty when addressed at normal rate






Understands almost everything, if addressed slowly and carefully






Requires frequent repetition and/or translation of words and phrases

(2)

ABILITY TO SPEAK









Speaks fluently, accurately and easily intelligible






Speaks intelligibly, but is not fluent or altogether accurate






Speaks haltingly, and is often at a loss for words and phrases

(3)

ABILITY TO WRITE









Writes with ease and accuracy






Writes slowly and/or with only moderate degree of accuracy






Writes with difficulty and makes frequent mistakes

(4)

READING ABILITY AND COMPREHENSION









Reads fluently with full comprehension






Reads slowly, but understands almost everything he reads






Reads with difficulty, and only with frequent recourse to the dictionary

(5)

OVERALL ASSESSMENT









Applicant’s knowledge is sufficient to follow *academic/*practical training programme (*cross out if not applicable):






Without further language training






After       months intensive language training in home country at      






After       months full time training in host country at      






After       months part time language training parallel with technical training in host country






Applicant’s knowledge is insufficient










(6)

Other remarks which may be of value in the development of the applicant’s training programme:

     







Language test has been administered by:

Name:      







Title:      







Address:      







Date:      







Signature:










Note: The applicant may be required to undertake language examination(s) to determine proficiency by a representative of the host Government before acceptance is received. Should this be requested the applicant must undertake the test required by the host Government or institution.




TC-2 Fel E/Rev.6 (May 03); old forms (TA-2EF/Rev.3, TA-2ES/Rev.4 and TC-2 Fel E/Rev.5) should be discarded and not used



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