2 Divinity Avenue | Cambridge, MA 02138 | U.S.A.

Tel: 617.495.3369 | Fax: 617.495.7798

Email: programs@harvard-yenching.org

HARVARD-YENCHING
INSTITUTE

Visiting Fellows Program

Application Deadline: September 30, 2010

2011-2012 Application Form

Applications should be sent by your universitys Foreign Affairs

Office to the above e-mail address.

Applicant Information
Family name: _______________________________
_ _________________

Age: __________

Given name: _ ______________________________

Gender:

Female

Male

Place of Birth (City and Country): _ ____________________________________________________________

Date of birth (mm/dd/yyyy): _________________________________________________________________
Citizenship (nation from which passport is obtained): _ ___________________________________________
Present title as faculty member: __________________

Anticipated date of Ph.D. completion: _________

University: _ __________________________________

Department: _ ____________________________

Office Address: ____________________________________________________________________________

________________________________________________________________________________________
Home telephone: ______________________________

Office telephone: _ ________________________

Cell phone: ___________________________________

Fax: _____________________________________

E-mail: __________________________________________________________________________________
Best mailing address: _______________________________________________________________________
________________________________________________________________________________________
Colleges/Universities attended
Name

Principal subject

Dates of Study

Degree/year awarded

__________________________

_ ________________

______________

_ ___________________

__________________________

_________________

______________

_ ___________________

__________________________

_________________

______________

____________________

__________________________

_________________

______________

_ ___________________

Letters of Recommendation

Please list the names and contact information of individuals from whom you are requesting letters of recommendation.
Three are required, one of which must be from your adviser or the person most familiar with your scholarly work. Please send the three
letters together with your application form.

1. Name: _______________________________

E-mail: _ _______________________________________

Address: _________________________________________________________________________________
Phone and Fax: _ __________________________________________________________________________
2. Name: _______________________________

E-mail: _ _______________________________________

Address: _________________________________________________________________________________
Phone and Fax: _ __________________________________________________________________________
3. Name: _______________________________

E-mail: _ _______________________________________

Address: _________________________________________________________________________________
Phone and Fax: _ __________________________________________________________________________
List 1-2 Faculty member(s) at Harvard University and/or any other major university in the United States
with whom you wish to consult during the stay of the fellowship. It is not necessary that you contact
faculty during the application process.
1. Name: _ __________________________ Institution: _ _________________________________________
Department and Field: _ ____________________________________________________________________
List one to two of the above faculty members publications (with detailed citation information) that are
highly relevant to your research:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
2. Name: ____________________________ Institution: _ _________________________________________
Department and Field: _ ____________________________________________________________________
List one to two of the above faculty members publications (with detailed citation information) that are
highly relevant to your research:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

Previous fellowships, scholarships, grants and other honors:

________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Are you applying for funding from any other organizations?

Yes

No

Have you ever applied for a Harvard-Yenching Scholarship before? _ ______ If so, when? _ _____________
Have you ever been issued a Harvard ID before?

Yes

No

Title of Dissertation: _______________________________________________________________________

________________________________________________________________________________________
Name and Academic Position of your Ph.D. Adviser: _ ____________________________________________
________________________________________________________________________________________
Employment (List all positions held, academic or other, in chronological order (with dates). Include the date
from which you have held your present faculty position):
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Publications (Please list titles in the original language as well as English. Attach a separate bibliography if
space here is insufficient):
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

Foreign Travel (If you have visited or lived in any countries other than the one in which you are now
employed, please list places, dates and purposes):
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Languages: indicate your knowledge of the languages listed below, and any others. If one is your own language, write native. Elsewhere, indicate slightly, fairly well or fluently.
ENGLISH
CHINESE
JAPANESE
KOREAN
THAI
VIETNAMESE
OTHER (_ _________ )
OTHER (_ _________ )

Speak: _ ______________
Speak: _ ______________
Speak: _ ______________
Speak: _ ______________
Speak: _ ______________
Speak: _ ______________
Speak: _ ______________
Speak: _ ______________

Read: _ ______________
Read: _ ______________
Read: _ ______________
Read: _ ______________
Read: _ ______________
Read: _ ______________
Read: _ ______________
Read: _ ______________

Dissertation
What is the subject of your Ph.D. dissertation? Please provide a 2-3 page description, indicating how far you
have progressed in writing it. Explain how a Visiting Fellowship at Harvard University would contribute to
your dissertation. Insert the extra pages into this application form as necessary.
Note to applicants: University transcripts must be sent together with this application.