Application form:

Graпts of the Representative of the Czech Republic in the Committee of Рlепiроtепtiаries of JINR

Title of the project :
Year: 2017
Name and institution of the applicant:
Name of the applicant responsible for the project on the JINR side:

Collaborating laboratory in JINR:

Additional collaborating institutions:
Abstract (max. 100 words):
JINR Topical Plan
No. of theme:
Title of theme:
Project team (including institution/laboratory)
For Czech Republic (name of team member + institution):
For JINR (name of team member + laboratory):
Other cooperating institutes/countries:
Results and activities performed on the subject of the project in previous year(s) (max 400 words, more complete report on the Graпt of the Representative in years 2015 and 2016 to be given in Annex):
______
Use of funds from Graпt of the Representative in years 2015 and 2016 (if applicable)
Total approved funding (USD): 2015 -
2016 -
Funding used on (in USD, please specify and insert rows if necessary):
2015 / 2016
Components
Equipment (specify)
Material
Services
International scientific and technical cooperation
Educational programs
Conferences, symposia
Total
Of that spent in
JINR/ Czech/foreign institutes/laboratories
Commentary (if necessary):
Use of research infrastructure in the project:
☐Nuclotron
☐Phasotron
☐FLNR accelerator complex
☐IBR-2 / ☐DRIBS
☐NICA
☐Other (RHIC, VdG etc., please specify):
Commentary (in the case several infrastructures were used etc.):
Goals and description of the project(max 400 words, may concern longer period than one year, more complete description can be given in Annex) :
Plan of activities for particular years(max 400 words, more complete description can be given in Annex) :
Requested funding and its justification(please specify and insert rows if necessary):
2017
Components
Equipment(specify)
Material
Services
International scientific and technical cooperation
Educational programs
Conferences, symposia
Total
Justification
List of other projects related to the submitted project in which the applicant/team is involved (3+3 grants /Grants ofthe Representative):
Results of the Graпts of the Representative project in years 2015 and 2016 (if applicable) (give list in Annex):
Publications (total):
Publications in Journal with impact factor (Jimp):
Other results:
Date / Signature of the applicant

CV of the applicant

Approval by statutory representative of the applicant

(not required for applicant on long-term stay in JINR)

I hereby declare that the project …. Is fully supported by…. and the research goals of the project are in line with the research plan of (institution)… and the results will be used by …

Date / Signature of the statutory representative

Approval by the Head of JINR laboratory

I support the project….

Date / Signature of the Head of JINR laboratory

Annexes

See text above and other informationconsidered as important by the applicant

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