Application form

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This application form should be returned by fax in one signed copy by 15 April 2002 to:

Prof. Annamaria Silvana de Rosa
Università degli Studi "La Sapienza"
Facoltà di Psicologia
Via dei Marsi 78 - 00185
Rome -Italy
fax n. 0039-06-4991 7652.
email: annamaria.derosa@uniroma1.it

(later applications will be considered if places are still available)

After the application form has been filled in, you may confirm its electronic transmission by pressing the button "Send" at the end of this page. If the transmission is successful, an acknowledgement will be displayed. At this point, you can request to have your filled in application form on the screen, in order to print it, to sign it and to send it as above stated. If you forget to print the application form after the transmission, you can print an empty application form and fill in it by hand in order to send it by fax.

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APPLICANT

Last name
First name
Sex (M/F)
Birth date (dd-mm-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 candidates (please, click only one of the following options):

I am applying for the 8^th Summer School:

as participant to the European PhD on S.R. & C.

as new candidate of the European PhD on S.R. & C. for 2002/2003

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

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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 attended (e.g. Tutor of Doctoral Programme, Head of Department, Professor).

Name
University
Relation with applicant

Brief comments on benefit of participation from the Supervisor

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My current research activity is focused on the following topic:

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I wish to present my research project during the Small Group Seminars (upon acceptance) with the following title:

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METHOD OF PAYMENT:

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

Amount of payment:

1000 Euro (400 Euro scientific participation fee + 600 Euro accomodation fee) for the participation in the 8th International Summer School 1000 Euro for the enrollement in the European PhD on S.R. & C. for academic year 2002/2003

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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 8^th International Summer School, by the Executive Comittee of the Euro PhD on SR & C