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APPLICATION FORM

Euroleague for Life Sciences - Summer School 2017

“Analysis and utilization of genomic diversity for plant breeding”

6 - 12 August 2017

University of Hohenheim, Stuttgart, Germany

Please complete this form on your computer, sign it and send a scanned version of the signed form to:

Dr. Gabriele Klumpp
Euroleague for Life Sciences (900)
University of Hohenheim, Fruwirthstr. 12, D-70599 Stuttgart, Germany

Application deadline: 31st March 2017 or until places are filled

Personal data

Family name:
First name(s): / Male: / Female:
Place and date of birth (day /month/year)
Current address
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Academic profile

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/ University:

Month and year of enrolment:

/ Planned date of completion
Language proficiency in English:
Listening/speaking: O basic O moderate O good
Writing: O basic O moderate O good
Motivation for participation in the intensive summer university:
Relevant prior studies/ academic background:
List and describe especially those courses you already passed in the field of plant genetics, plant breeding and/or statistics.
Describe why you consider this course important for your further study and career.
Describe your thesis title and topic and name your supervisor (if applicable)
Signature of applicant
I wish to apply for the ELLS Summer School “Analysis and utilization of genomic diversity for plant breeding”, 6 - 12 August 2017. I hereby confirm that the above information is correct.
I have been informed that I have to ensure adequate health insurance during the duration of the programme.
Date: / Signature:

For students from abroad

Alternative/Parents address (August 2017)
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Contact person in case of emergency
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