Umicore Materials Technology
2017 PhD Award
Fonds de la Recherche Scientifique-FNRS
Rue d’Egmont 5 – 1000 BRUXELLES
Tel. 02 504 92 40
E-mail: [email protected]  Website: http://www.frs-fnrs.be
received date
number
file
Form to return to the Fonds de la Recherche Scientifique-FNRS via the
address [email protected] by Monday July 3rd 2017 at the latest.
Details of the candidate
1 Enter your personal details.
first and surname
legal domicile address
private phone
department address
work phone
e-mail
birthplace
date of birth
nationality
civil status
day
month
year
gender
m
v
Umicore Materials Technology PhD Award 2017 – p.2 of 3
2 Enter the details of your university degrees.
Please state full and exact designation.
name of the degree
English name of the degree
Institution/
organisation
date (dd-mm-yyyy)
3 Enter your present occupation along with the coordinates of the according institution/organisation.
4 Enter the name and address of the current research unit to which you belong and the first and
surname of the head of this research unit.
Name:
Address:
Head of unit:
Details of your PhD research
Field of science and title
5 Describe the particular field of science of this research program in three keywords.
6 Select to which of the following fields your contribution belong.
Recycling / resources scarcity (related to metals)
Materials for catalysis
Materials for batteries
7 Give the English title of the research presented for the prize.
Use up to 240 characters, signs or spaces.
8 Enter the first and surname of the primary supervisor of the PhD thesis, the address of the institution
and the first and surname of de head of the research unit.
primary supervisor
address of the institution
head of the research unit
Umicore Materials Technology PhD Award 2017 – p.3 of 3
Details of scientific publications
9 Give an overview of your scientific publications and indicate those related to the prize.
For each publication, mention the following data:
 the title, completely without abbreviations
 the journal. Use only the international accepted abbreviations.
 the date of publication
 the number of pages, and for publications part of a book or magazine, the reference ‘from page x to page y’
 the names of the authors, according to the presentation order
 the impact factor of the journal
 the number of citations for each paper.
The F.R.S.-FNRS reserves the right to call for offprints.
National and international awards
10 List all your national and international awards.
Important! Please mention below all awards that you have received for your research.
Indicate for each award the following: the name of the award, the date received, the amount, the theme of the award and
the origin, i.e. the organization which provided the award.
name of the prize
date
amount
theme
origin
euro
euro
euro
euro
euro
Mandatory attachments
11 Enclose the following documents with this form and tick them in the tick list.
a detailed curriculum vitae
an electronic version of your PhD thesis
a summary in layman’s terms of max. ½ page
an executive scientific summary of max. 5 pages emphasizing the originality of the research
Signature of the applicant
12 Complete the following statement.
I confirm that I am in a position to freely interact with Umicore and that I am not an employee of Umicore or its branches,
nor have a I been an employee of Umicore or its branches before; the PhD research submitted here was not carried out
in collaboration with Umicore.
I declare that all information in this form is filled in truthfully.
date
handwritten signature
first name and last name
day
month
year