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ECP_TravelGrant _ApplicationForm v3 (word version)
Please fill in all the required information.
- 1. Applicant’s profile
Name and first name |
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Gender |
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Highest qualification |
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Department |
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University |
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Address |
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E-mail |
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Phone |
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Fax |
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List of publications |
Please provide the list of publications in a separate document added to this application form: |
Name of topic |
Please indicate the name of the topic that you need to deal with during your travel. This can be the title of the lecture, presentation, research project, new technology to be studied etc… |
Field description |
Please give in maximal 10 lines (250 words) the field in which your research is to be found and why this travel is so important to you and the field.
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2. Target event
Purpose of the travel |
Visiting research facility/participate at a conference/ other?
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Details of mission |
Title of conference/Address of research center and head of department. Please add a letter of acceptance of abstract, invitation etc. to this application form – is required information
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Dates |
Please provide date of departure and returnDate of departure:Date of return: |
Address |
Please give the full address where the mission is accomplished:
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Organized by |
Please give details about the people of the laboratory, congress organizer that co-organize your travel.
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Main theme of conf. |
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Title of abstract |
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Other financial resources. |
Are there any other financial resources that cover, at least partly, the same trip?
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3. Abstract to be presented as lecture, paper or poster
Maximum 250 words with (Title, authors (no affiliation), introduction, materials & methods, results (or expected results), discussion.
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4. Details of previous travel grants obtained from ECP or other subsidized travels (if any)
5. Undertaking by the applicant
I hereby undertake and affirm that:
- The substance of the research is original and conducted by me / us. In case any plagiarism is proved, apart from penalties imposed, I will refund the entire amount of grant to ECP
- The paper or research project has not been presented or studied before at any conference/workshop/lab etc. and also has not been published elsewhere
- All the information provided above is true to the best of my knowledge and belief
- If the grant is provided, I shall solely be responsible for its proper utilization and refund in case of cancellation of visit
- All the supporting documents submitted are authenticated
SIGNATURE OF THE APPLICANT |
6. Recommendations from Principle Investigator / Promoter / Head of department
I strongly recommend the request and certify that the applicant is a bona fide member of my department (please specify)
SIGNATURE of Principle Investigator / Promoter / Head of department
DATE
DEPARTMENT |
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