APPLICATION FORM FOR C-SEB VISITOR AND INTERNATIONAL FELLOWSHIP PROGRAM Application for (tick one program) VISITOR PROGRAM INTERNATIONAL FELLOWSHIP PROGRAM normally up to 2.500 € for junior and senior researchers at C-SEB normally up to 5.000 € for researchers from other research institutions to to go abroad for short-term visits at other labs and research units. visit C-SEB for short-term or long-term (up to 6 months) research stays. The C-SEB Visitor Program is open to all members of C-SEB that are employed at or receive a stipend from the University of Cologne. Any C-SEB member can act as a host and propose a candidate for the International Fellowship Program. 1. APPLICANT Permanent mailing address: Surname: Street: First name(s): Post/Zip Code, town, state: Academic title: Country: Telephone: Sex: Male Female Present position: Professor Junior-Professor Email: PostDoc Doctoral Student Other: Employed at (please specify the faculty, institute, seminar, chair): 2. HOST / GUEST Permanent mailing address: Surname: Street: First name(s): Post/Zip Code, town, state: Academic title: Country: Telephone: Sex: Male Female Present position: Professor Junior-Professor Email: PostDoc Doctoral Student Other: Employed at (please specify the faculty, institute, seminar, chair): 3. RESEARCH STAY Start/ End date: Anticipated total duration of the stay: Short statement of purpose (please add a detailed statement of purpose of 1-2 pages on a separate sheet): Center for Social and Economic Behavior (C-SEB) | Albertus-Magnus-Platz | 50923 Köln | Tel: +49 221 470 1146 | Fax: +49 221 470 5068 | Email: [email protected] 3. RESEARCH STAY Scientific contribution of research stay to C-SEB (please specify how C-SEB will benefit from this research stay): Further remarks (please use this section for any additional information on this research stay you feel is relevant which has not been provided elsewhere): 4. FUNDING Overall amount being applied for: Financial plan (please specify how you would use the money if granted): External funds: Do you receive funds for this? Guests Yes Travel If yes: Please name the source of your funding and how much you receive No Other material expenses (please specify) 5. ADDITIONAL INFORMATION (please use this section for any additional information which seems important to you in connection with this application) I certify that the information provided in this application is accurate to the best of my knowledge. Furthermore, I agree to inform C-SEB immediately of any changes and amendments. I have understood that any incomplete application or applications handed in after the deadline cannot be taken into consideration for the respective funding period. A complete application consists of the application form along with a statement of purpose (max. 2 pages) and the CV‘s of all involved researchers. I agree that this application and accompanying documents shall remain with C-SEB. I have read and understood the DFG Guidelines for Excellence Centers and Research Centers and the DFG‘s rules of good scientific practice, the UoC Guidelines for Excellence Centers, and the UoC Hospitality Guidelines and will comply with these rules. I am aware that it is my responsibility to ensure that collaborating researchers also adhere to these guidelines. I understand that disbursed funds may only be used for the research stay for which they were granted and must be paid back in case they were not spent at the end of the funding period. I agree to hand in a final report of 2-3 pages along with all receipts within one month after the funding period has ended. In this report I will provide information on the scientific progress achieved and on how the funds were spent using the categories of the financial plan outlined above. I am aware that non-compliance with any of these rules may lead to a reclaim of funds, irrespective of other potential implications. Place Date Signatur Center for Social and Economic Behavior (C-SEB) | Albertus-Magnus-Platz | 50923 Köln | Tel: +49 221 470 1146 | Fax: +49 221 470 5068 | Email: [email protected]