Tanzania Studies Assoication

Research Clearance Forms

TANZANIA COMMISSION FOR SCIENCE AND TECHNOLOGY

P.O. BOX 4302, FAX: (255-51) 75313, TEL: (255-51) 700745/6

DAR ES SALAAM, TANZANIA - EMAIL<rclearance@hotmail.com>

APPLICATION FOR RESEARCH CLEARANCE

  1. Applicant Personal Particulars

Surname:________________________________________________

Other names:______________________________________________

Title (Mr/Mrs/Ms/Miss/Prof/Dr) (Delete the inapplicable):_________

Nationality:_________________ Date of Birth: _____________

Highest academic qualification:______________________________

Institutional Affiliation: ____________________________________

Mailing Address:____________________________________

__________________________________________________

________________________________________

Country:_________________________________

Permanent address:___________________________________

__________________________________________________

  1. Title of proposed research project:_______________________________

__________________________________________________________

__________________________________________________________

  1. Purpose of research PhD/Master/Bachelor degree/others (specify) (Delete the inapplicable):_____________________________

  2. Research methodology (brief description)

__________________________________________________________

__________________________________________________________

5. Research objectives:

__________________________________________________________

__________________________________________________________

  1. Regions in Tanzania where research will be conducted: (select from: Arusha, Coast, Dar es Salaam, Dodoma, Iringa, Kagera, Kilimanjaro, Mara, Mbeya, Morogoro, Mtwara, Mwanza, Rukwa, Ruvuma, Shinyanga, Singida, Tabora and Tanga).

  1. Date research will commence __________________________
  2. Estimated period of research: __________________________________

  3. (a) Financial sponsor (Name & Address):

___________________________________

__________________________________________________________

(b)Research budget

  1. Contact address while in Tanzania:

__________________________________________________________

__________________________________________________________

  1. References (provide names and addresses of two referees, preferably one of whom should be based in Tanzania):

__________________________________________________________

__________________________________________________________

  1. Name of other applicants (if any):

_________________________________________________________

_________________________________________________________
13. Signature of applicant:______________________________________

CURRICULUM VITAE

  1. Surname:____________________________ (Mr/Mrs/Ms/Miss/Dr/Prof)

Other names:________________________________________________

  1. Citizenship:_____________________ Country of origin:_______________
  2. Date of Birth
  3. Mailing address (outside Tanzania)______________________________

__________________________________________________________
5 . Institutional affiliation :_______________________________________

__________________________________________________________

6 . University Education_________________________________________

Undergraduate

Degree

Year

Major subject

University

Country

Postgraduate

Undergraduate

Degree

Year

Major subject

University

Country

  1. Position held [start with current position]

    2. Position

    Year

    Institution

  2. Academic Awards:

    3. Award

    Year

    Awarding Institution

  3. Research Grants:

    4. Project

    Year

    Granting Institution

  4. Consultancies:

    5. 1.___________________________________________________________

    2.___________________________________________________________

  5. Refereed papers:

    6. 1.___________________________________________________________

    2.___________________________________________________________

    3.___________________________________________________________

    4.___________________________________________________________

    Other papers/ and or publications:

    1.___________________________________________________________

    2.___________________________________________________________

  6. Society Membership:

1.___________________________________________________________

2.___________________________________________________________

3.___________________________________________________________