Attach here photograph taken within the past year

Application will be considered incomplete if passport-size photograph is omitted.

Be sure to write your full name  on the photograph for identification should the photograph become accidentally detached. 
BELGIAN AMERICAN
EDUCATIONAL FOUNDATION, INC.
Established in 1920 by
The Commission for Relief in Belgium
195, Church Street, New Haven  CT  06510

Website:  http://www.baef.be

 

Graduate Fellowship for Study in Belgium 
Application for the year 20..... - 20.....

The Belgian American Educational Foundation, Inc. ( B.A.E.F.) is a non-profit organization, funded by the general public and qualified under 501 (c) (3) of the Internal Revenue Service Code. The  B.A.E.F.  fellowships were established in 1920 by the C.R.B. Educational Foundation, the predecessor of the B.A.E.F., to commemorate the relief work of the Commission for Relief in Belgium during World War I. The fellowships are intended to promote the exchange of intellectual ideas between Belgium and the United States for the purpose of maintaining the cordial relations that exist between the two countries. 

The information requested below must be typed or printed carefully, otherwise the application will not be considered.  (Whenever the space provided on this form is insufficient for a full presentation of the facts, please use separate sheets.)

Applications and accompanying documents must reach the Belgian American Educational Foundation Inc., 195 Church Street, New Haven  CT  06510, no later than October 31 of the year preceding the year of fellowship.

PERSONAL HISTORY

1. Name ...........................................................................................  2. Soc. Sec. # ........................
                          (Last)             (First)  (Middle)
3. Permanent address ............................................................................................................................................
......................................................................................................................................................................
Tel.  ..........................................................................           Fax ........................................................................
     Mailing address...................................................................................................................................................
.................................................................................            e-mail: ...................................................................
Tel.  ...........................................................................          Fax .........................................................................
5. Place of Birth ...............................................................       6. Date of Birth (Day/Mo./Yr)....................................
7. Citizenship  ..................................................................       8.  Nationality at birth .............................................
9. Marital status  .............................................................       10. Date of marriage  (Day/ Mo./Yr)..........................
11. Spouse's name in full ..........................................................................................................................................
12. Spouse's place and date of birth .................................................................... Citizenship  ...............................
13. Name, place and date of birth of children...........................................................................................................
...........................................................................................................................................................................
...........................................................................................................................................................................
14. Persons who will accompany you to Belgium. If other than spouse or children, give relationship, place and date of birth ................................................................................................................................................................
...........................................................................................................................................................................
15. Give name and address of parent, or next of kin, in the United States  .......................................................
..............................................................................................................................................
....................................................................................................................... Tel.  ..........................................
 
EDUCATION

16. College or university degrees and diplomas 
 Institution Degree Date of Award Distinction
 
................................................................................................................................................................................................................... 
................................................................................................ 
............................................................................................................................................................................................ 
........................................................................................................
17. ATTACH OFFICIAL TRANSCRIPTS OF BOTH UNDERGRADUATE AND GRADUATE COURSES OF STUDY.
18.  List any scholastic honors or other evidence of high scholarship ......................................................................
....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
19. Are you now a candidate for any degree?  If so, what degree? From what institution? And at what date? ....................
..........................................................................................................................................................................................................................................................................................
20. Give title and date of completion of any thesis already presented or now in preparation ..........................................
..........................................................................................................................................................................................................................................................................................
21.   Do you use the French language readily?  Estimate your proficiency in speaking, reading, and writing French? .............................................................................................................................................
How was your knowledge of French obtained?  ...............................................................................................
.............................................................................................................................................
22. Do you use the Dutch language readily?  Estimate your proficiency in speaking, reading, and writing Dutch? .............................................................................................................................................
How was your knowledge of Dutch obtained?  ................................................................................................
.............................................................................................................................................
23. Name any other languages you can read  .....................................................................................................
and speak ................................................................................................................................

EXPERIENCE AND ACCOMPLISHMENTS
24. Positions held (professional, teaching, scientific, administrative, etc.)

 Name of institution or organization Title or Position Years of tenure
Give dates
 ............................................................................................................................................................................................................................ .................................................................................................................................................
.................................................. ....................................................................................
............................
 

25. What is your present occupation?  (be specific)   .........................................................................................
.........................................................................................................................................................................
26. List any scientific or professional distinctions awarded to you  (Submit a separate sheet if necessary) .....................
...............................................................................................................................................................
.........................................................................................................................................................................
.........................................................................................................................................................................
27. Name any learned, scientific, or artistic societies of which you are a member  (Submit a separate sheet if necessary)..
.......................................................................................................................................................................................................................................................................................................................................................................................................................................
28. List your principal publications with exact titles, names of publishers and date (Submit a separate sheet if necessary)
Title                                                                           Date and Place of Publication                   Name of Publisher
.......................................................................................................................................................................................................................................................................................................................................................................................................................................
29. Have you lived outside the U.S.?  Name the countries and approximate length of stay in each  ............................ ..........................................................................................................................................................................................................................................................................................
30. ATTACH A BRIEF AUTOBIOGRAPHY IN NARRATIVE PROSE OF ABOUT ONE PAGE.

STUDY PLANS

31. To which field of learning will your project contribute?  Give title of project............................................................
.....................................................................................................................................................................................................................................................................................................................
32. At what Belgian university or institution do you plan to study?  ..........................................................................
.............................................................................................................................................
33. Have you already established relationships with professors, scholars, or researchers in your field in Belgium?  If so, give names and addresses. 
.............................................................................................................................................
.............................................................................................................................................
34. ATTACH SEPARATE SHEETS WITH A TYPEWRITTEN STATEMENT PROVIDING (1) AN ACCOUNT OF THE ADVANCED WORK OR RESEARCH YOU HAVE ALREADY ACCOMPLISHED; (2) A DESCRIPTION OF YOUR PRESENT PROJECT OR PLAN OF STUDY IN BELGIUM, INCLUDING NAME OF UNIVERSITY, LABORATORIES, AND PROFESSORS, WHERE AND WITH WHOM YOU HOPE TO WORK; (3) THE BENEFITS YOU EXPECT TO OBTAIN FROM SUCH A TRIP.
35. If awarded a fellowship:
When would you wish to leave the U.S.?  ......................................................................................................
How long do you plan to stay in Belgium? ........................ in other countries abroad?  ......................................
36. To what definite position in the U.S. do you expect to return after your stay abroad?  .............................................
.............................................................................................................................................

REFERENCES

37. Please request three references to submit confidential letters of recommendation either to the Belgian American Educational Foundation directly or to your appropriate Dean for forwarding to the Foundation.  At least one of the three references should testify your adequate knowledge of either the French, Dutch, or German language. 
List below the names and addresses of your references.
 Name                                                                  Position                                               Mailing Address
 .............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................

ADDITIONAL INFORMATION
38. Have you applied or do you expect to apply for any other fellowship or scholarship for the same academic year as that of this application? If yes, state which other  fellowship or scholarship and for which country.
..................................................................................................................................................................................................................................................................................................................................................
39. While holding the fellowship, what income or salary do you anticipate receiving from other sources?  .......................
.............................................................................................................................................................
40. If you do not receive funding from the Belgian American Educational Foundation and if instead you were to receive an honorary B.A.E.F. Fellowship, would it still be possible for you to go to Belgium to study?        Yes (   )            No   (   )
41. Give any additional facts or data that you believe might aid the consideration of your application. ............................
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
42. List any documents, printed or written, submitted with this application (If you wish documents returned, please so state).......................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................

Signature ...........................................................................

Place and Date ..................................................................

The Belgian American Educational Foundation, Inc. reserves the right to withdraw a fellowship and terminate payment of the stipend in case of conduct that is, in the opinion of the Foundation or its representatives, prejudicial to the interests of the Foundation or to the objects that it is seeking to promote.
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