Mrs. Mr.
First name(s)*:
Last name*:
Academic Title:
Professor
Ph.D.
BA
MA
Date of Birth*:
Nationality:
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua & Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia & Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Burma (Myanmar)
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
East Timor
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Great Britain
Greece
Granada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
The Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Northern Ireland
Oman
Pakistan
Palau
Palestinian State
Panama
Papua New Guinea
Paraguay
Peru
The Philippines
Poland Portugal
Qatar
Romania
Russia
Rwanda
St. Kitts & Nevis
St. Lucia
St. Vincent & The Grenadines
Samoa
San Marino
São Tomé & Príncipe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunesia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
Unites Arab Emirates
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Yemen
Zaire
Zambia
Zimbabwe
Home Institution*:
Position and Status at Home Institution:
Professor
Postdoc
Ph.D./Doctoral Student
Street/Nr.*:
Zip Code*:
Town*:
State /Province:
Country*:
Fon:
Fax:
Email*:
Arrival*:
End of stay*:
Host institution*:
Contact Person at the host institution:
Last Name*:
First name*:
Email*:
Will you sign a work contract with Bielefeld University?
Yes No
Funding Body:
Self financed
Alexander von Humboldt-Foundation
Cusanuswerk
Degussa Foundation
Erasmus
Erasmus Sokrates
Evangelisches Studienwerk e.V. Villgist
Foundation of German Business (Stiftung der Deutschen Wirtschaft)
Friedrich-Ebert-Foundation
Friedrich-Naumann-Foundation
Fritz-Thyssen-Foundation
Fulbright Commision
Gerda-Henkel-Foundation
German Academic Exchance Service DAAD
German Research Foundation DFG
Hans-Böckler-Foundation
Heinrich-Böll-Foundation
Hertie-Foundation
Konrad-Adenauer-Foundation
Rosa-Luxemburg-Foundation
Schering-Foundation
Volkswagen Foundation
World University Service
Other
Please name your funding body, if your reply to the previous question was "other":
Funding Body
Status at Bielefeld University:
Professor
Postdoc
Doctoral Student
Purpose of stay:
Research
Teaching
Research and Teaching
Research area in Bielefeld*:
Will you be accompanied by your spouse?
Yes No
How many children under the age of 18 will accompany you?
Children:
0
1
2
3
4
5
more than 5
Have you previously been to Bielefeld University?
Never
1 time
2-4 times
more than 5 times
If you have been to Bielefeld University, please indicate your status during your previous stay: (multiple answers are permitted):
degree seeking student
exchange / non degree student
Ph.D/Doctoral Student
Postdoc-Scholarship holder
Visiting Scholar
Conference Speaker
Regular University Staff
Other:
What kind of cooperation were you engaged in with Bielefeld University so far?
I attended workshops and conferences at Bielefeld University
I carried out joint research projects with scholars from Bielefeld University
I published together with scholars from Bielefeld University
There is student exchange between my home university and Bielefeld University
none
Other:
Please indicate the areas in which you would like to get more information and support from the Welcome Unit of Bielefeld University:
Housing
Language Course
Health Insurance
I would like to get information via email about activities and events of the Welcome Service.
Your preferred language of communication:
The information you provided will be solely used for the preparation and organisation of your (intended) stay at Bielefeld University. If necessary, your data will be passed onto your host department and other University institutions. Your contact details will be used to keep you updated with news for international scholars at Bielefeld University and with alumni activities. Your information will not be passed to third parties without your prior consent. Statistical surveys will only be realised in anonymised form. You way withdraw your consent to the storing and processing of your data at any time. Your personal details will be deleted two years after leaving Bielefeld University.
I have read the declaration of consent and hereby agree to it.