NOMINATION FORM

AGNES JUNIOR SCIENTIST GRANTS 2022

(Complete one form per Nominee)

Name and Nationality of Candidate:

(Print Name of Candidate)

Signature of Candidate to accept the conditions and undertakes to apply for an AvH scholarship.

TYPE OF APPLICATION: AGNES Junior researcher Grant

Discipline of PhD (e.g. Biology): ……………………………………………………………..

Subdiscipline/field of research (e.g. Marine Biology/Animal Physiology):

………………………………………………………………………………………………….

Title of PhD thesis / date of completion: ………………………………………………………

Title of best publication: ……………………………………………………………………….

Proposed Field of Study in Germany: ………………………………………………………….

Research Partner in Germany and Affiliation: …………………………………………………

Your Ranking of this Applicant (e.g. 1st out of my 2 candidates):

Full Motivation for nominating this candidate (Maximum of 200 words):

…………………………………………………………………………………………………..
…………………………………………………………………………………………………

Name, signature and academic affiliation of Nominator:

Print Name of AGNES Member Signature and Date

Checklist for Submission

 Please make use of a tick in each box in order to show that the application
is fully completed.
 CV with a full list of publications plus a digital copy of each publication (Only the first page
showing Authorship, Title and Date of the publication, Abstract and Journal
information).

 Completed Nomination form

 Screenshot or scanned first page of each publication

 For the Humanities, an extended abstract of the doctoral thesis (5 pages) has to be submitted

 Academic transcripts and graduation certificates of degrees from the Tertiary Institute(s)