International Centre for Genetic Engineering and Biotechnology



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The ICGEB SMART Fellowship programme promotes the mobility of researchers between ICGEB Member States* as a way of enhancing skill development, acquisition of specific hands-on training in new technologies and increasing cooperation in science and technology.

Closing Dates for Applications: 31 March & 30 September

APPLICATION FORM

|SURNAME:       |

|FIRST NAME:       |

|MAILING ADDRESS (FOR COURIER DELIVERY):       |

|E-MAIL:       |

|TEL:       |FAX:       |

|DATE OF BIRTH (DD/MM/YY):       |AGE:       |SEX: M F |

|PLACE OF BIRTH:       |NATIONALITY:       |

PROJECT TITLE:

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FELLOWSHIP DURATION AND PROPOSED STARTING DATE

|Duration:       (3 to 9 months maximum) |Starting date:       |

For internal use only

|Application Number: |Date of receipt: |

|(assigned by ICGEB) | |

*Afghanistan, Algeria, Argentina, Bangladesh, Bhutan, Bosnia and Herzegovina, Brazil, Bulgaria, Burkina Faso, Burundi, Cameroon, Chile, China, Colombia, Costa Rica, Côte d’Ivoire, Croatia, Cuba, Ecuador, Egypt, Eritrea, Ethiopia, Hungary, India, Iran, Iraq, Italy, Jordan, Kenya, Kuwait, Kyrgyzstan, Liberia, Libya, Malaysia, Mauritius, Mexico, Montenegro, Morocco, Namibia, Nigeria, North Macedonia, Pakistan, Panama, Peru, Qatar, Republic of Moldova, Romania, Russian Federation, Saudi Arabia, Senegal, Serbia, Slovakia, Slovenia, South Africa, Sri Lanka, Sudan, Syrian Arab Republic, Trinidad and Tobago, Tunisia, Turkey, United Arab Emirates, United Republic of Tanzania, Uruguay, Venezuela, Viet Nam, Zimbabwe

PART 1 – TO BE COMPLETED BY THE APPLICANT

|For our records, please indicate the scientific field in which you work (please tick one box only) |

| Basic Sciences | Industrial and agricultural biotechnology |

|Human Health |Environmental bioremediation |

|PERSONAL INFORMATION |

|Please remember to attach a photo of yourself as a separate JPEG file and copy of your passport, even if expired. Only the page with personal |

|details is required. |

|IMPORTANT: in completing this form, please provide your surname and name exactly as they are indicated in your passport. |

|Gender: Male Female |Passport No.:       |

|Date of birth:       |Date of issue:       |

|Place of birth (Country):       |Place of issue:       |

|Nationality:       |Date of expiry:       |

|ACADEMIC / PROFESSIONAL INFORMATION |

|Degree Awarded |Year |Field/Discipline |University |

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|Are you registered for a PhD degree at your home laboratory:       (Yes or No) |

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|Registration starting date:       (DD/MM/YYYY) |

|PRESENT EMPLOYMENT |

|Name and address of employer |Position |From – To |

|      |      |      |

|Field of specialization:       |

|Honors / awards / scholarships received, if any:       |

|Applicant’s 5 most recent and important publications (also enclose curriculum vitae and full list of publications, in English, with this |

|application) |

|1)       |

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|2)       |

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|3)       |

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|4)       |

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|5)       |

|RECEIVING LABORATORY INFORMATION |

|Name and mailing address of laboratory to be visited: |

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|Phone:       |Fax:       | |

|Name of the head of the receiving laboratory to whom a copy of this application will be sent: |

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|E-mail:       |

|Previous visits to the receiving laboratory: (give dates and purpose) |

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|Details concerning the visit for which the applicant is requesting support: |

|Length of stay |Expected date of arrival in host country |Expected date of return to home country |

|(min. 3 and max 12 months) |      |      |

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|PROJECT INFORMATION |

|Project Title: |

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|Purpose of the visit and brief outline Research Project: |

|(Define specific research activities to be pursued during the project period and provide a comprehensive description of the techniques to be used |

|and the advantages of the suggested methodological approach. Please include any selected relevant references. Maximum 5 pages, including |

|references) |

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|Timetable: |

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|Facilities available in the receiving institution: |

|(Provide a detailed list of the infrastructure and equipment available and necessary for the proposed research) |

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|Reasons for selecting this particular hosting laboratory for this fellowship: |

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|SIGNATURE OF THE APPLICANT: |

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|Signature       Place       Date       |

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|IMPORTANT NOTE: Please note that unsigned applications cannot be accepted |

|REFERENCES |

|Name and contact details of two (2) referees who can provide a letter of reference on your behalf. At least one of these should be a member of the |

|University or College you attended most recently. Please request referees to send their letters by e-mail to fellowships@ by the |

|application closing date. The subject of the e-mail should be: “The Arturo Falaschi ICGEB SMART Fellowship Programme” followed by your name. |

|Please DO NOT attach the reference letters to the application |

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|Referee 1 |

|Referee 2 |

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|PART 2 – TO BE COMPLETED BY THE APPLICANT’S HOME LABORATORY |

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|NAME AND POSITION OF THE HEAD OF THE HOME LABORATORY |

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|Statement in support of the applicant’s visit |

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|We hereby confirm that the statements made by the applicant are correct and that he/she is authorized to apply for an ICGEB SMART Fellowship, which|

|will be necessary to carry out the proposed research. |

| |

|Brief outline of the expected benefits from this training activity: |

|      |

|SIGNATURE OF THE HEAD OF HOME LABORATORY: |

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|Signature       Date       |

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|IMPORTANT NOTE: Please note that unsigned applications cannot be accepted |

PART 3 - TO BE COMPLETED BY THE HEAD OF RECEIVING LABORATORY

|RECEIVING LABORATORY INFORMATION |

|Name and mailing address: |Phone:       |

|      | |

| |Fax:       |

| |E-mail:       |

| |Web page:       |

|Name/position of head of the receiving laboratory: |Name of prospective visitor: |

|      |      |

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|E-mail:       | |

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|Name of prospective supervisor: | |

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|E-mail:       | |

|Facilities made available at the host institution: |

|(The receiving Institution is expected to provide all necessary research facilities and laboratory consumables to enable the agreed research |

|training programme to be effective) |

|      |

|Additional support offered locally (if available): |

|      |

|Statement in support of the application including potential value to the host laboratory |

|      |

|SIGNATURE OF THE HEAD OF THE RECEIVING LABORATORY: |

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|Signature       Date       |

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|IMPORTANT NOTE: Please note that unsigned applications cannot be accepted |

|NAME AND SIGNATURE OF THE LEGAL REPRESENTATIVE OF THE HOST INSTITUTION: |

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|We hereby confirm that in case of award this Institution will make the bench fees assigned by ICGEB to this ICGEB SMART Fellowship immediately |

|available for the Fellow and free from any administrative overheads (kindly refer to the Guidelines attached herewith). |

|A pro-forma invoice will be provided in order to receive the bench fee payment. |

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|Name:       Signature       Date       |

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|IMPORTANT NOTE: Please note that unsigned applications cannot be accepted |

ATTACHMENTS

|CHECKLIST |

|Please ensure that ALL relevant attachments are included in the completed application form |

| |

|The completed application form |

|Copy of passport, even if expired (only the page with personal details is required) |

|Applicant’s CV and publications list (in English) |

|Curriculum Vitae of the Head of the Receiving Laboratory and complete list of publications (in English). Please do not send/attach papers |

Disclaimer

The data provided by completing this application form, including your personal data (i.e. name, surname, address, telephone number and e-mail address) will be transferred and/or disclosed (when applicable) to the University in which you will be registered and/or to other non commercial parties for the sole purpose of completing the application process. The disclosure of this data is voluntary. If technically feasible and where reasonable, data, although stored in ICGEB database for statistical purposes, may be used without disclosing personal information or by use of anonymised data or aliases. Your data will be handled according to principles of lawfulness, fairness and transparency, and ICGEB will process them only for the purposes for which they were requested.

By submitting this form you hereby authorize and consent to us processing (including disclosing) your personal data and any updates of your information to the University and/or to other non commercial parties, for the purposes indicated above. If you do not consent or subsequently withdraw your consent to the processing and disclosure of your personal data, ICGEB will not be able to fulfill its obligations, or to contact you, or to assist you in respect of the purposes indicated above. However you can withdraw your consent by writing an email to: fellowships@

Application guidelines

|PURPOSE |THE PROGRAMME PROMOTES THE MOBILITY OF RESEARCHERS BETWEEN ICGEB MEMBER STATES AS A WAY OF ENHANCING SKILL |

| |DEVELOPMENT, ACQUISITION OF SPECIFIC HANDS-ON TRAINING IN TECHNOLOGIES AVAILABLE IN THE RECEIVING LABORATORY AND |

| |INCREASING BILATERAL COOPERATION IN SCIENCE AND TECHNOLOGY, AND SHOULD SHOW CLEAR EVIDENCE OF STRONG |

| |COLLABORATION BETWEEN THE TWO LABORATORIES. |

| | |

| |Applicants should focus on the impact for the fellow’s career, the benefit to the applicant’s home laboratory and|

| |the suitability of the receiving laboratory. |

|Subject Area |Applications are welcome in any area of the Life Sciences. |

|Eligibility |The call is open to nationals of ICGEB Member States and provides fellowships to scientists in the early stage of|

| |their career wishing to spend between 3 and 9 months at a research institution in an ICGEB Member State other |

| |than their own. |

| |SMART Fellowships are intended to promote collaboration among researchers in ICGEB Member Countries. |

| |Fellowships for mobility support to laboratories located in Italy, India or South Africa can be considered under |

| |exceptional circumstances and only if the research activity proposed is not covered by one of the ICGEB |

| |laboratories in Trieste, New Delhi or Cape Town. If this latter case applies please refer the ICGEB Arturo |

| |Falaschi Short-term fellowships programme. |

| |There is no age limit. However, preference is given to young scientists at the beginning of their research |

| |career. |

| |Applicants should be either registered for a PhD or have obtained their PhD degree within the last 5 years. Young|

| |scientists holding an MSc or equivalent can apply. |

| |Awards are not intended to prolong visits begun under other auspices; to support participation in courses, |

| |workshops or symposia or as bridging fellowships between, or prior to, long term stays funded by ICGEB or other |

| |organizations. |

|Terms and Benefits |Awards are for a minimum of 3 to a maximum of 9 months. The fellowship covers international economy return |

| |travel, health insurance plus subsistence of the fellow only. The stipend ranges from US$ 800 to 1,500 per month |

| |according to local conditions in the receiving country and seniority of the applicant. Additionally, a US$ 500 |

| |monthly bench fee can be paid directly to the receiving laboratory based on the recommendation of the ICGEB |

| |Fellowships Committee. |

| |The fellowship stipend will be paid, by bank transfer, directly to the fellow’s bank account. Upon joining the |

| |receiving laboratory, ICGEB will transfer the bench fee allocation to the receiving laboratory, which will be |

| |responsible for the management of the funds and the certification of expenditures to ICGEB. The receiving |

| |laboratory is expected ensure that adequate provisions are in place for the specific research project and to make|

| |the bench fee allocation available to the ICGEB SMART Fellow immediately, free from any administrative overhead |

| |costs. |

| | |

| |ICGEB makes no financial provision, nor can it provide administrative support for family members of participants |

| |in the programme. |

|Bench fees |The bench fee allowance paid in the framework of the ICGEB SMART fellowship is a contribution to the |

| |implementation of the research project proposal presented by the candidate. |

| | |

| |The receiving laboratory is expected to use the entire bench fee allocation to the benefit of the approved |

| |research-training programme. Any unspent balance left will have to be returned to ICGEB. |

| | |

| |Funds can only be used to cover the purchase of laboratory consumables that that are directly related to the |

| |SMART Fellow’s research activities including: |

| | |

| |general labware, cryoware, glassware and plasticware |

| |chemicals and reagents |

| |cell culture consumables |

| |pipettes and pipette tips |

| |microplates |

| |PCR and qPCR consumables |

| | |

| |The following items are not considered eligible costs: |

| | |

| |Costs of maintenance, repair, running or insurance of existing assets belonging to the Host Institute |

| |Purchase of equipment, office furniture or fittings |

| |Computer hardware or software |

| |Office stationary |

| |Travel costs |

| |Literature |

| |Administrative costs and overhead expenses of the Institute |

| |Bank charges |

|Selection |The ICGEB Fellowships Selection Committee will evaluate complete applications received by the closing date. The |

| |candidates will be notified of the outcome by e-mail as soon as possible following the closing date for |

| |applications. |

| |The main criteria for selection include scientific excellence of the project, the qualities of the candidate’s CV|

| |and the impact on the his/her career, the potential benefit for the home and the host country, competence, skills|

| |and equipment available in the receiving laboratory. ICGEB will positively value any additional support provided |

| |by the receiving institute to the fellow’s living expenses (i.e. a direct contribution for living expenses, guest|

| |house accommodation, etc.) |

|Submission |Please complete the application form in all parts and return this form, by email, together with all attachments |

| |to: |

| |ICGEB Fellowships Unit |

| |ICGEB, Padriciano 99, I-34149 Trieste, Italy |

| |E-mail: fellowships@, Tel: +39-040-3757382, Fax: +39-040-226555 |

|Final report |Successful candidate will jointly prepare a final scientific report with the host supervisor highlighting the |

| |achievements attained during the period of the Fellowship. |

| |The host Institute will submit a signed financial statement reporting the expenditure covered by the bench fee |

| |allowance received. |

Revised: 21/01/2020_BA

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