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					EXPERT MEETING                                                                                 ESCON
Grant application form                                                      EXPERT MEETING scheme
Please refer to Explanatory Notes when completing this form



Registration form (basic details)



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1a. Details of main applicant/expert meeting organizer
-Name, title(s):
-Male/female:
-Address for correspondence:
-Telephone:
-Fax:
-E-mail:
-Website (optional):

-Doctorate (date):

1b. Title for proposed research collaboration meeting


1c. Summary of proposal
(max. 300 words, plus max. 5 KEYWORDS)




Proposal – Outline of the Planned Research Collaboration Meeting


2. Description of Planned Research Collaboration
(max. 4000 words on max. 8 pages, excl. literature references and optional utilisation paragraph).

2a. Research topic

2b. The Novel Integration

2c. Objectives of the Meeting

2d. List of Participants
Fill out for each one separately

-Name, title(s):
-Address for correspondence:
-Telephone:
-Fax:
-E-mail:


2e. Literature references

2f. Name 3 potential referees for the proposed Expert Meeting
[1]
-Name, title(s):
-Address for correspondence:
-Telephone:
-Fax:
-E-mail:
[2]
-Name, title(s):
-Address for correspondence:
-Telephone:



                                                   1
EXPERT MEETING                                                             ESCON
Grant application form                                        EXPERT MEETING scheme
Please refer to Explanatory Notes when completing this form


-Fax:
-E-mail:
 [3]
-Name, title(s):
-Address for correspondence:
-Telephone:
-Fax:
-E-mail:




                                                  2
EXPERT MEETING                                                                   ESCON
Grant application form                                           EXPERT MEETING scheme
Please refer to Explanatory Notes when completing this form




Cost estimates

3 Proposed venue for the expert meeting:



3a. Budget
Expenses Per Person                    Travel         Hotel      Food            TOTAL

Initials Surname

Initials Surname

Initials Surname

Initials Surname

Initials Surname

Initials Surname

Initials Surname

Initials Surname

Initials Surname

Initials Surname

Initials Surname

Initials Surname

TOTAL



3b. Do you intend to request any additional grant for the proposed EXPERT MEETING from any
other institution? yes/no (If ‘yes’, see Notes)




                                                  3
EXPERT MEETING                                                             ESCON
Grant application form                                        EXPERT MEETING scheme
Please refer to Explanatory Notes when completing this form


PLEASE COMPLETE THIS FORM SEPARATELY FOR EACH PARTICIPANT

Curriculum vitae


4a. Personal details
Title(s), initial(s), first name, surname:
Male/female:
Date and place of birth:
Nationality:
Address:
Email:

4b. Current Position

4c. International activities

4d. Other academic activities

4e. Scholarships and prizes



List of publications


5. Publications:
-International (refereed) journals


-Books, or contributions to books




                                                  4
EXPERT MEETING                                                              ESCON
Grant application form                                         EXPERT MEETING scheme
Please refer to Explanatory Notes when completing this form



Signature

I hereby declare that I have completed this form truthfully:

Name:

Place:

Date:




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