GEOMETRIC ANALYSIS
			RESEARCH TRAINING NETWORK

			    APPLICATION FORM
			    ----------------

Title (MSc, ...):

Current family name:

First name:

Birth family name: 

Date of birth (dd/mm/yyyy):
Gender (F/M):

First nationality:

Second nationality:

Place of permanent residence:


From when:
Address:



E-mail:                                   Fax:

------------------------------------------------------------------------
Date of award of pre-doctoral university diploma (dd/mm/yyyy):

Title and subject area of pre-doctoral university diploma:


Institution where candidate acquired last diploma/qualification -
Organisation Legal Name:
Town/City:
Country:

Ph.D. student in (place):

Ph.D. studies started in       year
Expected date of award of doctorate:

Ph.D. advisor:

Areas of research (subject area of doctorate):


Scientific experience:
a) publications:

b) conferences attended:

c) fellowships, research visits:

d) number of years of fulltime research (post-graduate level):

Describe scientific interests (research program) - not more than 1 page: 


----------------------------------------------------------------------

Institution where candidate has most recently been doing research under 
a paying contract -
Organisation Legal Name:
Town/City:
Country:

Place(s) of normal activity during the previous three years -
Region:
Country:
From (dd/mm/yyyy):     			To (dd/mm/yyyy):

Previous fellowships -
Has the candidate held a Community Fellowship before?
If yes, please give below details of the contract -
Programme name:
Type of fellowship:
Contract period from (dd/mm/yyyy):		to (dd/mm/yyyy):

-------------------------------------------------------------------------

Expected length and period of visit in GA RTN:


Additional information which the candidate considers as important: