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1、1编号： 中国科学院外国专家特聘研究员计划推荐表推荐单位名称（盖章） 外籍专家姓名 外籍专家国别 申请来华期限 中国科学院国际合作局制年 月 日2姓 名性 别 出生日期国 籍 职 位电 话 E-Mail传 真 研究领域 工作单位 联系地址 外国科学家简历主要学术和技术成就在国外机构任职情况在国际组织任职情况国际期刊任职情况承担项目情况外国专 家的基 本情况曾获得的主要国际学术奖外国专 家在我 院工作 计划安 排外国科学家在我院期间的具体合作研究项目、学术交流、科研指导、人 才培养、拟解决问题等活动计划（包括详细的时间节点）依托单 位推荐 意见单位负责人（签章）： 依托单位名称（加盖单位公章）
2、： 年 月 日3姓 名性 别 职 务研究领域 电 话E-Mail 手 机传 真合作者 信息 学术水平 介绍4APPLICATION FOR CHINESE ACADEMY OF SCIENCES VISITING PROFESSORSHIP FOR SENIOR INTERNATIONAL SCIENTISTS 1. Name in Full2. Gender3. Date of BirthFamily First MiddleMale Female Day Month Year4. Nationality5.Citizenship6. Permanent Residence7. Curren
3、t Appointment and/ or StatusTitle:Division:Institution:8. Academic Degree (Ph.D.)Type:Date Obtained (or Expected)Field: / University:Country:Day Month Year9. Higher Education (Starting from the latest)Name of University / InstitutionLocationDegreeFieldCompletion Date (Month/Year)10. Previous Employm
4、ent (Starting from the latest)Name of InstitutionLocationPositionFrom to (Month/Year)11. Academic Awards (Please indicate title, year and conferrer.)12.Research Field and Specialization13. Name of Proposed Host Researcher and Host InstitutionHost Researcher:Title:5Division:Host Institution:14. Resea
5、rch project in CAS (up to 100 letters including spaces and symbols)15. Proposed Tenure of CAS Visiting ProfessorshipFrom:/to/Total:Day Month Year Day Month Year Months16. Research Plan in CAS: Please include at least the following items:a. Present research relevant to proposed research planb. Purpos
6、e of proposed researchc. Proposed Pland. Expected results and impacts617. Subject and Achievement of Past Research718. List of Major PublicationsAuthors (all,) Year Title, Journal, Vol, No., pp.- 819. Language Ability (5: excellent 1: poor)Reading WritingHearingSpeaking English5 4 3 2 15 4 3 2 15 4
7、3 2 15 4 3 2 15 4 3 2 15 4 3 2 15 4 3 2 15 4 3 2 15 4 3 2 15 4 3 2 15 4 3 2 15 4 3 2 15 4 3 2 15 4 3 2 15 4 3 2 15 4 3 2 1Chinese5 4 3 2 15 4 3 2 15 4 3 2 15 4 3 2 120. Past Stay(s) in CASPlace:Year:Purpose:21. Name(s) of other fellowship(s) for which you are now applying22. Mailing Address(Approxim
8、ately three months after receiving an application, CAS will send out fellowship-commencement documents, so care should be taken to ensure that the address will remain valid. Please check Office or Home; unless otherwise stated we will send the documents to your Office.）Office:Home:Tel:Tel:Fax:Fax:E-
9、mail:E-mail:23. Will you be accompanied by spouse and/or offspring(s)? If so, please indicate their names and relationship.Name: Relationship:24. If you have been previously awarded as a CAS fellowship or participated in another CAS research program, please indicate the name of the program and the period of your participation.Name of the program:Period of participation:9I certify the above information to be accurate and correct.Date: Name (Print): Signature: (Applicant signature)