Application Form for young researchers for a grant to attend

The Joint Meeting

 July 3 - 7 2006

For further information please contact the organizers at  fano@dm.unito.it

Tel: +39 011 6702881  Fax: +39 011 6702878

THE DEADLINE FOR APPLICATIONS IS  April 12 th 2006


Surname:

 Forename(s):
Title:
 Professional status:
FULL postal address of Department:
 Additional address info:
Nationality: Date of Birth (dd/mm/yy):
Sex: M
F
Telephone: Fax:
e-mail:
Proposed Arrival Date: Proposed Departure Date:
PhD thesis (or dissertation) title : Date: Supervisor:

Brief curriculum vitae since graduation:

Current or projected research activities related to the topic of this workshop:

Applicant's Scientific Publications. List no more than 5 most significant (or most recent) publications related to the topic of the workshop - give title of paper, journal, volumes and page numbers, authors (in case of preprints, provide download links):

Will your institution/research grant to fund your visit?

If partial support is requested, please specify nature, amount and likelihood of available support

Have you applied for a grant for this purpose from any other body?

If yes, with what result?

FUNDING

If you wish to be considered for support, please complete the following additional questions:

 

Do you wish to apply for funding to cover lodging costs?

Do you wish to apply for funding to cover travel costs?

If YES, please provide estimated costs for travel (using most economical air or second class rail fares): express all amounts in euros.

From To Means of Transport Return/Single Cost

If funding is not awarded  will you still be able to attend?

Please specify

I declare the above truthful and sincere.