University of Michigan African Presidential Scholars Program 2011 Application and General Information Form

African Studies Center International Institute∙International Institute1080 S.. University, Suite 3603 University of Michigan Ann Arbor, MI 48109-1106 Tel +1 734 615 3027 Email: asc-conta

African Studies Center International Institute∙International Institute

1080 S University, Suite 3603 University of Michigan Ann Arbor, MI 48109-1106 Tel +1 734 615 3027 Email: asc-contact@umich.edu

University of Michigan African Presidential Scholars Program 2011

Application and General Information Form

Surname (as it appears on your passport) (Last, First, Middle)

Other Names (as they appear on your passport): (first, middle, etc.)

University Name

Number of years as faculty in an institution of higher education

University Address (street or PO Box, City, Code)

Permanent Mailing Address (if different from institution address)

Telephone number (mobile) Fax number (if applicable)

Length of Proposed Residency (number of months, beginning September, 2011)

Title of Proposed Research Project

_ Names of Suggested University of Michigan Faculty Mentors (if any)

Research Abstract (max 100 words)

Research Statement: Please attach to this form a statement of proposed research that does not exceed five double-spaced pages in length If proposing to do research, please include discussion of your methodology If proposing a research collaboration, indicate your research partners If proposing a period of writing, indicate the scope of your writing project and goals

Due date for application is December 1, 2010.