application - vsuru：应用vsuru

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1、PleasePrintLASTNAMEFIRSTNAMEProposedCASEAffiliationCarnegieResearchFellowshipProgramAPPLICATIONAProgramoftheNationalCouncilforEurasianandEastEuropeanResearch(NCEEER)InconjunctionwiththeAmericanCouncilsforInternationalEducation:ACTR/ACCELSSupportedWithaGrantfromCarn

2、egieCorporationofNewYorkThisapplicationmustbecompletedinEnglish,exceptwherespecified.Applicationsshouldbetypewrittenwheneverpossible,otherwisepleasePRINTlegibly,inblackink.ApplicationsmustbesubmittedbyApril30th,2008totheACTR/NCEEERMoscowOffice:PleasePrintLASTNAMEFI

3、RSTNAMEProposedCASEAffiliationAmericanCouncils/NCEEERLeninskiiProspekt,dom2,kom.526a/ya1Moscow119049,RussiaАмериканскиеСоветыпомеждународномуобразованию/NCEEERЛенинскийпроспект,дом2,ком.526А/я1119049Москваtel:(495)647-9839fax:(495)956-7806e-mail:alexei@nceeer.orgww

4、w.nceeer.orgPleasePrintLASTNAMEFIRSTNAMEProposedCASEAffiliationTHISAPPLICATIONMAYBEDUPLICATEDANDISFREEOFCHARGE.1.NAMEPleaseprintyournameinLatinletters(asitappearsonyourinternationalpassportifyouhaveone).Donottranslate(i.e.,writeYuriiPetrovich,notGeorgePeter).______

5、______________________________________________________________________________________________LastNameFirstNamePatronymic2.GENDER(pleasecircleone):MaleFemale3.CITIZENSHIP___________________________________(DonotlistUSSR)Attachrecentphoto4.AGE_______5.DATEOFBIRTH___

6、__/______/________MonthDayYear6.PLACEOFBIRTHcity:_____________________country:___________________PleasePrintLASTNAMEFIRSTNAMEProposedCASEAffiliation7.MAILINGADDRESS(theaddressatwhichyoureceiveyourmail)_____________________________________________________________

7、_______________________________________CountryCityPostalIndex____________________________________________________________________________________________________StreetNameDomKorpusKvartira(_________)__________________________________________________________________

8、_________CitycodeTelephone(home)AnothercontacttelephoneE-mailaddress8.maritalstatus(pleasecircleone)MarriedSingleWidowedDivorced9.children(please