Travel Grant Application Form

ECP Trave lGrant Application Form v3 (pdf)

or

ECP_TravelGrant _ApplicationForm v3 (word version)

 

 

Please fill in all the required information.

  1. 1.       Applicant’s profile
Name and first name
Gender
Highest qualification
Department
University
Address  
E-mail
Phone
Fax
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? 

 
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 

 
Dates Please provide     date of departure and returnDate of departure:Date of return:
Address Please give the     full address where the mission is accomplished:  

 

 
Organized by Please give     details about the people of the laboratory, congress organizer that     co-organize your travel.  

 

 
Main theme of conf.
Title of abstract
Other financial resources. Are there any     other financial resources that cover, at least partly, the same trip? 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

        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. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    4. Details of   previous travel grants obtained from ECP or other subsidized travels (if any)

Date

Conference visited
   
   
   
   
   
   

 

 

 

 

 

 

 

 

    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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