David Baumgardt Memorial Fellowships/Fritz Halbers Fellowship

Please complete this form in quadruplicate and return it to the Leo Baeck Institute.

• Application for:
  
  
  1. David Baumgardt Memorial Fellowship [ ]
     
     
  2. Fritz Halbers Fellowship [ ]
  
  
• Name (Last, First, Middle Initial):
  
  
• Address:
  
  
• Tel.:
  
  
• Citizenship:
  
  
• Social Security Number:
  
  
• Date of Birth
  
  
• Place of Birth
  
  
• Command of German (good, fair, poor, nil)
  
  
• Other Languages
  
  
• Educational Background

• Present Position or Status:
  
  
• Awards, academic honors, fellowsips held:
  
  
• Have you done research at the LBI before?
  
  
  1. yes, date: .........
     
  2. no
  
  
• Please list institutions where you have pursued similar research projects:
  
  
• Project: Concise title and description of proposed project, please describe in detail on a separate sheet of paper
  
  
• Institution with which you will be affiliated upon completion of the fellowship:
  
  
• What other organizations have you applied to for finanacial support?
  
  
• Signature
  
  
• Date

Appliation materials will not be returned. No reason for a decision will be given.