BEST Program Scientific and technological exchange grants Form Project title: 1re Application to the BEST Program Have you ever applied with the DPF before? If yes, under what program? Start of grant requested / / No JEAI ATS PEERS Yes ARTS Total time requested LMI months Applicant ■■ Marital Status - Civilité - Birth Name Last Name (passport) First Name (passport) Date of Birth / / Nationality Mobile : ■■ City of Birth Country of birth Email : Highest degree obtained Type of Degree - Sélectionnez Year of Graduation (yyyy) Degree Course - Sélectionnez Exact title of the degree Issued by Name Country ■■ Other degree - PhD or Master's (if applicable) Type of Degree - Sélectionnez Year of Graduation (yyyy) Degree Course - Sélectionnez Exact title of the degree Issued by Name Country ■■ Occupational information Occupational status - Sélectionnez Job title - Sélectionnez Institutional affiliation Date hired / / Date assumed duties Name of the laboratory/team Head of the Facility - Civilité - Last Name First name Job title - Sélectionnez - / / ■ Your business contact information Street Address Details BEST Program - Application Form 2015 1 PO Box Zip Code City Country Email Phone ■■ Fax Postal address for following up on your file (if different from above) Street Address Details PO Box Zip Code Topic (see appendix) City Country - Sélectionnez - IRD Unit IRD Project Coordinator - Civilité - Last Name First name Email Phone Accreditation to supervise research (HDR) Number of students currently supervised ■■ - Sélectionnez - No. No Yes Pending Project Summary (1500 characters maximum, including spaces) BEST Program - Application Form 2015 2 Goal per stay: Goal per stay: Goal per stay: Goal per stay: BEST Program - Application Form 2015 3 ■■ Calendar of stays Host team ■■ Country Co-financing (Acquired) Name of source Grant (or equivalent) Travel expenses City No. Mont hs No from to / / / / / / / / / / / / / / / / / / / / / / / / Yes Request pending - Sélectionnez - Sélectionnez - Other expenses - Sélectionnez - BEST Program - Application Form 2015 4 Research Facility 1 ■■ Identification Code (if applicable) IRD Department Acronym (if applicable) Topic (see appendix) Full name Supervisory Institution 1 Supervisory Institution 2 (if applicable) Supervisory Institution 3 (if applicable) Supervisory Institution 4 (if applicable) Head of the Facility - Civilité - Last Name First Name ■■ - Sélectionnez - Sélectionnez - Host team 1 ■ Facility Name of the laboratory/team Acronym (if applicable) Host institution Mailing address/Street address Mailing address/Details PO Box Zip Code City Country ■ Applicant's scientific correspondent Email - Civilité - Last Name Institutional affiliation Occupational status - Sélectionnez Job title - Sélectionnez Topic Code (see appendix) - Sélectionnez Accreditation to supervise research (HDR) Phone Fax ■■ First Name No Yes Pending Host team 2 (if applicable) ■ Facility Name of the laboratory/team Acronym (if applicable) Host institution Mailing address/Street address Mailing address/Details PO Box Zip Code City Country ■ Applicant's scientific correspondent Email - Civilité - Last Name Institutional affiliation Occupational status - Sélectionnez Job title - Sélectionnez Topic Code (see appendix) - Sélectionnez Accreditation to supervise research (HDR) Phone Fax BEST Program - Application Form 2015 First Name No Yes Pending 5 Research Facility 2 ■■ Identification Code (if applicable) IRD Department Acronym (if applicable) Topic (see appendix) Full name Supervisory Institution 1 Supervisory Institution 2 (if applicable) Supervisory Institution 3 (if applicable) Supervisory Institution 4 (if applicable) Head of the institution - Civilité - Last Name First Name ■■ - Sélectionnez - Sélectionnez - Host team 1 ■ Facility Name of the laboratory/team Acronym (if applicable) Host institution Mailing address/Street address Mailing address/Details PO Box Zip Code City Country ■ Applicant's scientific correspondent Email - Civilité - Last Name Institutional affiliation Occupational status - Sélectionnez Job title - Sélectionnez Topic Code (see appendix) - Sélectionnez Accreditation to supervise research (HDR) Phone Fax ■■ First Name No Yes Pending Host team 2 (if applicable) ■ Facility Name of the laboratory/team Acronym (if applicable) Host institution Mailing address/Street address Mailing address/Details PO Box Zip Code City Country ■ Applicant's scientific correspondent Email - Civilité - Last Name Institutional affiliation Occupational status - Sélectionnez Job title - Sélectionnez Topic Code (see appendix) - Sélectionnez Accreditation to supervise research (HDR) Phone Fax BEST Program - Application Form 2015 First Name No Yes Pending 6 Research Facility 3 ■■ Identification Code (if applicable) IRD Department Acronym (if applicable) Topic (see appendix) Full name Supervisory Institution 1 Supervisory Institution 2 (if applicable) Supervisory Institution 3 (if applicable) Supervisory Institution 4 (if applicable) Head of the Facility - Civilité - Last Name First Name ■■ - Sélectionnez - Sélectionnez - Host team 1 ■ Facility Name of the laboratory/team Acronym (if applicable) Host institution Mailing address/Street address Mailing address/Details PO Box Zip Code City Country ■ Applicant's scientific correspondent Email - Civilité - Last Name Institutional affiliation Occupational status - Sélectionnez Job title - Sélectionnez Topic Code (see appendix) - Sélectionnez Accreditation to supervise research (HDR) Phone Fax ■■ First Name No Yes Pending Host team 2 (if applicable) ■ Facility Name of the laboratory/team Acronym (if applicable) Host institution Mailing address/Street address Mailing address/Details PO Box Zip Code City Country ■ Applicant's scientific correspondent Email - Civilité - Last Name Institutional affiliation Occupational status - Sélectionnez Job title - Sélectionnez Topic Code (see appendix) - Sélectionnez Accreditation to supervise research (HDR) Phone Fax BEST Program - Application Form 2015 First Name No Yes Pending 7 APPENDIX Research Subject Code Atmosphere Earth's Crust Soil Oceans Continental waters Renewable energy resources Non-renewable mineral resources Micro-organisms Natural continental ecosystems Exploited continental ecosystems Coastal, estuarine, and lagoon ecosystems Continental aquatic ecosystems Marine ecosystems Annual crops species grown Perennial crops grown Fruit species Horticultural species Forest species Aquatic plant species Continental animal species Aquatic animal species Humanities Societies OTHER ATM CRT SOL OCE ECO RER RMN MOR ENC EEC ECE EAC EOC ESA ESP ESF ESH ESS ESV ANC ANA HUM SOC XXX 001 002 003 004 005 006 007 008 009 010 011 012 013 014 Topics Code Development and governance Vulnerability, inequality and growth Social and spatial dynamics and borders Infectious diseases, especially emerging and forgotten diseases Nutrition Diseases of civilisation Plant-health interactions Vulnerability and climate change Natural hazards and risks Water resources Food production and safety Ecosystems and Biodiversity Sustainable energies and transport Other BEST Program - Application Form 2015 8
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