DFG							Deutsche												Forschungsgemeinschaft
								
German House
2, Nyaya Marg, Chanakyapuri
New Delhi 110021 / India
Tel.	+91 11 4168 0490
Fax	+91 11 4168 0494 
E-Mail: Krishnan.Hariharan@newdelhi.dfg.de

This questionnaire is intended to keep our database up to date so that we can keep in contact with you. We would very much appreciate if you could kindly complete this questionnaire and return the same to us at the above address by post or per email. To electronically store details on alumni, including your details, we need your permission.

INSA-DFG Exchange of Scientist’s Programme
Questionnaire

Family Name		
First Name 		
Date / Place of birth		

Sex	Male    Female 	

Residential Address

		
Tel No. 		
Mobile No.		
Email Address		

Office Address

		
Tel No.		
Fax No.		

Mailing Address Preference	     Office Address                           Residential Address 	

Field of Study		
Area of Specialization:		

Current Employment		
Present Position		

Year & Duration of Visit	     	

German Institute/s visited	Host at the German Institute/s	

		

Duration of other visits to Germany	Programme	From                                          To	

			

Research Co-operations/Contacts with German Partners

Partner in Germany	Institution	Scope of Cooperation	

			

Are you interested in receiving additional information from DFG? If yes, please specify:

 General Information on DFG Programmes 	 German Research Magazine	

 DFG Annual Time Planner

I herewith give my consent to the DFG for storing my personal details for the purpose of carrying out follow-up contact work and keeping in contact with me as part of the alumni activities. The DFG will not pass on my details to any third parties.

Date / Place: ____________________________________	Signature: _______________________________

Please note that you are free to choose whether or not you wish to fill out and sign the above the above declaration of consent. If you choose to consent, all the details you provide in this questionnaire will be stored for the alumni activities of the DFG. You are also free to choose not to answer individual points of the alumni sheet. Choosing not to fill out the questionnaire or not to have yours details stored will be of no disadvantage to you.

Your details will be stored permanently, although you can choose to revoke your declaration of consent at any time without indicating reasons. This will result in all details relating to you being deleted immediately.