European Doctorate on Social Representations and Communication
10th International Summer School

10th International Summer School of the European PhD on Social Representations & Communication
SOCIAL INFLUENCE AND COMMUNICATION
IN THE NEW SCENARIOS OF THE INFORMATION SOCIETY
 Is it possible to change risk behaviour?
 Colonna Castle, Genazzano - Rome (ITALY), 24th April -   3rd May 2004

This application form should be returned by fax in one signed copy by 20 March 2004 to:
(Later applications will be considered if places are still available)

Prof. Annamaria Silvana de Rosa
European  Doctorate on Social Representations and Communication Research Center and Multimedia Lab
Università degli Studi "La Sapienza" Facoltà di Psicologia
Piazza dell'Ara Coeli, 1 - 00186 Rome -Italy
Tel. n. 0039 0669380814 - Fax n. 0039 0669294280
email: annamaria.derosa@uniroma1.it

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APPLICANT

Last name
First name
Sex (M/F)
Birth date (mm-dd-yy)
Nationality
HOME ADDRESS
Tel. No.
Fax No.
E-mail
ADDRESS FOR CORRESPONDENCE
(if different from above)
Tel. No.
Fax No.
E-mail
PLACE OF WORK (city and country)

Typology of application (please, click only one of the following options):

I am applying for the 10th Summer School:

as enrolled student in the European  Doctorate on Social Representations and Communication
as new candidate of the European  Doctorate on Social Representations and Communication for 2004/2005
as Marie Curie Fellow
as a self paying participant

QUALIFICATION First university or equivalent graduation

University Graduation date Discipline Qualification Grades

Brief curriculum vitae since graduation (relevant qualification):

Scientific publications (give the references of no more than 5, your best or most recent):

Knowledge of European Languages spoken level written level

REFERENCES (please include a brief comment signed by the person below indicated):

Name and Institution of a person to whom reference may be made about your suitability to pursue the Summer School. The person should be a EURO PhD NATIONAL TUTOR or SOCRATES PARTNER (IC Nº 29415-IC-1-99-1-IT ERASMUS-EPS-1), or, in any case, a senior member of the staff of the respective University, Polytechnic or College which you attend (e.g. Tutor of Doctoral Programme, Head of Department, Professor).

Name
University
Relation with applicant

Brief comments on benefit of participation from the Supervisor

My current research activity is focused on the following topic:

I wish to present my research project during the Parallel thematic workshops (upon acceptance) with the following title:

METHOD OF PAYMENT:

The deadline and method of payment will be communicated with the letter of acceptance.

Amount of payment:
2.600 Euro (1.500 Euro scientific participation fee + 1.100 Euro accomodation fee) for the participation in the 10th International Summer School
3.500 Euro for the new candidates accepted for the enrollement in the European  Doctorate on Social Representations and Communication for academic year 2004/2005
  For the applicants already enrolled in the European Ph.D. the fees will be the same of the last academic year:
2.000 Euro for those enrolled since the academic year 2002/2003
1.500 Euro for those enrolled before the academic year 2002/2003

APPLICATION FOR HLSC FUNDING

Since I meet with the eligibility criteria, I would like to apply for HLSC funding*

* Approval of funding requests will be done simultaneously with the selection of the participants of the 10th International Summer School, by the Executive Comittee of the European  Doctorate on Social Representations and Communication