| P.O. Box 586 | Telephone: | +39 040 2240111 | ||||||||||||||||||||||
| I - 34100 Trieste | Cable: | CENTRATOM | ||||||||||||||||||||||
| Italy | Telex: | 460392 ICTP I | ||||||||||||||||||||||
| Telefax: | +39 040 224163 | |||||||||||||||||||||||
| E mail: smr1222@ictp.trieste.it | ||||||||||||||||||||||||
ICTP, Trieste, Italy
25 April - 12 May 2000
| INSTRUCTIONS | |||
|---|---|---|---|
| Each question must be answered clearly and
completely. Type or print in ink. If more space
is required, attach additional pages. The request
for participation form should be forwarded to: The Abdus Salam International Centre for Theoretical Physics, School on Vanishing Theorems and Effective Results in Algebraic Geometry (c/o Ms. A. Bergamo), P.O. Box 586, I - 34100 Trieste, Italy to arrive no later than 10 January 2000.
| A recent photograph of the candidate should be attached here, signed legibly on the reverse. | ||
For women
(if applicable)
SURNAME/FAMILY Name: MAIDEN Name First name(s) Middle name(s) Sex
..................... ................. .................. ................ ....
IMPORTANT: PLEASE ALSO COMPLETE THIS SECTION, IF YOUR NAMES IN YOUR PASSPORT, ARE SPELT
DIFFERENTILY FROM THE ABOVE.
For women
(if applicable)
SURNAME/FAMILY Name: MAIDEN Name First name(s) Middle name(s) Sex
..................... ................. .................. ................ ....
Place of birth Present nationality Date of birth
................................... ................... .....................
(City and Country) (year - month - day)
Full name & address of permanent Institution:
Institute: Tel. no.:
Cable:
Telex:
Telefax:
Your Office: Tel. no.:
Telefax:
e-mail *:
Full name & address of present Institution (if different from permanent):
Institute: Tel. no.:
Cable:
Telex:
Telefax:
Your Office: Tel. no.:
Telefax:
e-mail *:
Until: Date ...........................
My e-mail address(es) may be made public on the ICTP WWW page:
Yes /__/ No /__/
Home address: Tel. No.:
Mailing address - Please indicate whether:
Permanent Institution /__/ or Present Institution /__/ or Home /__/
Name and address of person to notify in case of emergency - Relationship:
Tel No.:
EDUCATION (higher degrees)
University or equivalent Years attended Degrees
Name and place From To
Seminars, summer schools, conferences and/or research
Name and place Year
SCIENTIFIC EMPLOYMENT AND ACADEMIC RESPONSIBILITIES
Research Institution or University Period of duty Academic Responsibilities
Name and place From to
Present employment and duties, and foreseen employment upon return to home country after
the activity:
Have you participated in past ICTP activities. Yes /__/ No /__/
If yes, which?
Are you applying to any other 2000 ICTP activities? Yes /__/ No /__/
If yes, which?
Mention briefly your previous research experience, and explain your reasons for wishing
to participate in this activity:
NB Our scientific Information System keeps track of all applications made by the candidate
to earlier ICTP activities. As a consequence, when the subject of the present activity is far
from his/her previous applications,an explanation(not more than 200 words) of your change of
interest should be included.
Present field of interest (please indicate on the list below YOUR - TWO primary fields
of interest, in order of priority, 1 and 2.)
10. PHYSICS OF CONDENSED MATTER 60. PHYSICS TEACHING
11. Solid State Physics 61. English
12. Atomic and Molecular Physics 62. French
13. Materials Science 63. Spanish
14. Surfaces and Interfaces 64. Arab
15. Statistical Physics
16. Computational Physics in Condensed Matter
20. PHYSICS OF HIGH AND 80. MISCELLANEOUS
INTERMEDIATE ENERGIES
21. High Energy and Particle Physics 81. Others
22. Relativity, Cosmology and Astrophysics 82. Digital Communications
23. Plasma Physics and Computer Networking
24. Nuclear Physics
90. PHYSICS OF THE LIVING STATE
91. Neurophysics
92. Biophysics
30. MATHEMATICS 93. Medical Physics
31. Applicable Mathematics including:
- Mathematical Ecology,
- Systems Analysis,
- Mathematical Economy,
- Mathematics in Industry AO. APPLIED PHYSICS
33. Algebra
34. Geometry A1. Physics in Industry
35. Topology A2. Microelectronics
36. Differential Equations A3. Fibre Optics for Communications
37. Analysis A4. Instrumentation
38. Mathematical Physics A5. Synchrotron Radiation
A6. Non-destructive Evaluation
A7. Lasers
40. PHYSICS AND ENERGY AA. Applied Superconductivity
41. Physics of Nuclear Reactors
42. Physics of Controlled Fusion
43. Non-Conventional Energy B1. SPACE PHYSICS
(Solar, Wind and others)
50. PHYSICS AND ENVIRONMENT
51. Solid Earth Geophysics
52. Soil Physics
53. Climatology and Meteorology
54. Physics of the Oceans
55. Physics of Desertification
56. Physics of the Atmosphere, Troposphere
Magnetosphere, Aeronomy
57. Environmental Monitoring and Remote
Sensing
Kindly supply (strictly within indicated lengths) a keyword description of your current
scientific activities as follows:
1) Area of research (e.g. AlG> GEOM.)
|________________________________________|
(strictly no more than 15 letters)
2) Specific topic of interest (e.g. VANISHING THEOREMS)
|_______________________________________________________________|
(strictly no more than 30 letters)
List your scientific publications including books and articles (authors,
title, Journal) in the period 1992-1999:
Kindly state any positions you hold in the scientific administration of your
Institution or of the national scientific Institutions.
It would be of assistance to the Selection Committee if this request for participation
were accompanied by a letter of recommendation, especially for junior physicists.
Indicate below your proficiency in the English language
Reading: Good /__/ Writing: Good /__/ Speaking: Good /__/
Average /__/ Average /__/ Average /__/
Poor /__/ Poor /__/ Poor /__/
APPLICABLE ONLY FOR CANDIDATES FROM DEVELOPING COUNTRIES
(Important: Owing to limited funds, support for travel will be granted only in exceptional
cases. Therefore, every effort should be made by applicants to secure support for their fare
(or at least a partial contribution) from their home country).
Request for Financial Assistance: (Please tick ONE box only)
Full Travel + Subsistence /__/ Subsistence only /__/
Half Travel + Subsistence /__/ No financial support requested /__/
I certify that if granted funds for my travel
by ICTP I will attend the whole activity
Signature ........................................
I certify that the statements made by me above are true and complete. If accepted,
I undertake to refrain from engaging in any political or other activities which would
reflect unfavourably on the international status of the Centre. I understand that
any breach of this undertaking may result in the termination of the arrangements
relating to my visit at the Centre.
___________________________________________ ________________________________
Signature of candidate Date
TO BE COMPLETED ONLY BY ELIGIBLE YOUNG RESEARCHERS IN EUROPE WISHING TO APPLY FOR A EUROPEAN COMMISSION GRANTDo you or your research group hold a grant from which participation in the event could be funded? Yes /__/ No /__/ Have you applied for a grant for this purpose from any other body? Yes /__/ No /__/ If yes, what was the outcome of your application? I wish to apply for a European Commission grant to attend the event. I am requesting support for: (Please tick ONE box only) Half Travel + Subsistence /__/ Full Travel + Subsistence /__/ Subsistence only /__/ If requesting support for travel expenses, please also provide the information requested below. Estimated costs of travel to Trieste (using the most economical air or second class rail fare): From To Means of Transport Return/Single Cost ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- --------------------------------END OF APPLICATION--------------------------------------
Please report any problem on this page to zetto@ictp.trieste.it.
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