Formulaire de demande de bourse de thèse

BEST Program
Scientific and technological exchange grants
Form
1re Application to the BEST Program
Have you ever applied with the DPF before?
If yes, under what program?
Start of grant requested
/
/
No
Yes
Total time requested
months
Applicant
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Marital Status
- Civilité - Birth Name
Last Name (passport)
First Name (passport)
Date of Birth
/
/
Nationality
Mobile :
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City of Birth
Country of birth
Email :
Highest degree obtained
Type of Degree
- Sélectionnez Year of Graduation (yyyy) 0
Degree Course
- Sélectionnez Exact title of the degree
Issued by
Name
Country
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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 -
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/
■
Your business contact information
Street Address
Details
BEST Program - Application Form 2014
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PO Box
Zip Code
City
Country
Email
Phone
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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)
Project title:
Goal per stay:
Goal per stay:
Goal per stay:
Goal per stay:
BEST Program - Application Form 2014
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Calendar of stays
Host team
Country
BEST Program - Application Form 2014
City
No.
Mont
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from
to
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Co-financing (if applicable)
Name of source
Grant (or equivalent)
Travel expenses
No
Yes
Request pending
- Sélectionnez - Sélectionnez - Other expenses - Sélectionnez -
BEST Program - Application Form 2014
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Research Facility 1
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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 2014
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 2014
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 2014
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 2014
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