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Application for Visitors Program 2006

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* Applications close: 26 November 2004 *

Applications to be forwarded to:

Director
Humanities Research Centre
Old Canberra House #73
Lennox Crossing
Australian National University
Canberra ACT 0200
AUSTRALIA
or
F: + 61 2 6125 1380
E: Leena.Messina@anu.edu.au

Visitorship category:

(Tick category of Visitorship being applied for)

Visiting Fellow (with grant)

Visiting Fellow (with partial grant)

Fellow (2006) (with no grant)

Applicant’s details:

Surname ....................................................... Title .................................... Initials ................................

Given names ........................................................................................................................................

Male / Female .................... Year of birth ............................

Country of citizenship: _____________________________

Contact information:

Address: ____________________________________________________________________

____________________________________________________________________________

T: _____________________________________ F: __________________________________

E: _________________________________________________________________________

Current appointment (include position and institution):

___________________________________________________________________________

___________________________________________________________________________

Proposed period of Visitorship:

Jan 2006-March ......... April-June ......... July-Sept ......... Oct-Dec 2006

Specify exact 12 weeks and/or dates if possible: __________________________

Have you previously been a Visitor to the ANU (please circle):

Yes / No

If yes, which year and what capacity?

___________________________________________________________

___________________________________________________________

Do you consider your project fits within the broad theme (please circle)?

Yes / No

Curriculum Vitae:

All applicants should provide a copy of their Curriculum Vitae, including a list of publications that are most relevant to their proposed topic of research.

Proposed Project:

______________________________________________________________________________
PROPOSED PROJECT TITLE:

______________________________________________________________________________

Include a one-to two-page description of the research project (approx. 1500 words).

Referees:

Please provide the names of three persons, their addresses and contact details, who are able to provide comments in relation to this application.

Name of No. 1 Referee: ____________________________________________________

Contact address: _____________________________________________________________

______________________________________________________________________________

E-mail address: ______________________________________________________________

Name of No. 2 Referee: ____________________________________________________

Contact address: _____________________________________________________________

______________________________________________________________________________

E-mail address: ______________________________________________________________

Name of No. 3 Referee: ____________________________________________________

Contact address: _____________________________________________________________

______________________________________________________________________________

E-mail address: ______________________________________________________________

Please forward a copy of the Referees Report Form to your nominated referees, requesting that they submit this direct to the HRC by the closing date for applications. The Referee's Report is available at: Referee's Report

To my best knowledge, this application meets the objectives, restrictions, conditions, and guidelines of the 2006 Humanities Research Centre Visiting Fellowship Program.
Please tick:

How did you hear about the 2006 HRC Visiting Fellowship Program? Please circle.

1. HRC WWW advertising
2. Email
3. Newspaper (which one?)
4. Flyer
5. Friend
6. Other: Please supply…………………………