Application Form AMC-MG
AMC registration
MAS - Short-term Mobility Grants
For UK-applicants
2017
Title and full name________________:________________________________________________________________________________
Date of Birth:____/______/_______ (dd/mm/yy) Age:_________Nationality:______________________________________________
Institution, Country and Date PhD Awarded:________________________________________________________________________
Research area: Exact Sciences:
Natural Sciences:
Social Sciences and Humanities:
Engineering:
Research specialization area:_______________________________________________________________________________________
___________________________________________________________________________________________________________________
Present research:___________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Current work Institution:______________________________________________________________________________________________
Start date of present employment:___________________________________________________________________________________
Department:________________________________________________________________________________________________________
Current post:________________________________________________________________________________________________________
General information:
Work Address:_____________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Office  : ______________________________Mobile  :____________________________E-mail:______________________________
VISIT AND PROJECT INFO
Research Project title:______________________________________________________________________________________________
___________________________________________________________________________________________________________________
General purpose: _________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Benefits of research to individuals and institutions:____________________________________________________________________
___________________________________________________________________________________________________________________
Tentative dates of visit:______________ , 2017 -- ______________ , 2017 or 2018 (up to three months; visits have to start in 2017)
month
month
Number of weeks:_____________________________________________ from four (minimum) to 12 weeks (maximum)
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Title and full name of Mexican co-applicant: ___________:_____________________________________________________________
Host Institution in Mexico: __________________________________________________________________________________________
Previous contact with Mexican co-applicant (dates and joint research work):___________________________________________
___________________________________________________________________________________________________________________
PERSONAL DETAILS OF THE MEXICAN CO-APPLICANT
Title and full name:_________:______________________________________________________________________________________
Date of Birth:_______/______/_______ (dd/mm/yy)
Nationality:___________________________________________________
Institution, Country and Date PhD Awarded:_______________________________________________________________________
Current work Institution:___________________________________________________________________________________________
Department:______________________________________________________________________________________________________
Start date of present employment:__________________________________________________________________________________
Current post of the Mexican Co-applicant:__________________________________________________________________________
Research specialization area:______________________________________________________________________________________
__________________________________________________________________________________________________________________
Present research:__________________________________________________________________________________________________
Office  : ______________________________Mobile  :____________________________E-mail:____________________________
INSTITUTIONAL REFERENCES
MEXICAN INSTITUTIONAL REFERENCE:
MUST BE THE HEAD OF DEPARTMENT OF THE MEXICAN CO-APPLICANT OR THE AUTHORITY WHO WILL APPROVE THE LETTER
SPECIFIED AT POINT 7) OF THE CALL.
Head of Department of the Mexican Co-applicant or Institutional Authority (name, phone and e-mail):___________________
______________________________________________________________________________________________________________________
UK INSTITUTIONAL REFERENCE:
MUST BE THE HEAD OF DEPARTMENT OF THE UK APPLICANT OR THE AUTHORITY WHO WILL APPROVE THE LETTER SPECIFIED AT
POINT 8) OF THE CALL.
Head of Department of the UK applicant or Institutional Authority (name, phone and e-mail):____________________________
_____________________________________________________________________________________________________________________
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