«International Research»Thesis Award 2017
SOCIAL SCIENCE AND HUMANITIES
Application form
1. Personal information of the nominee
Surname:First Name:
Home address:
Professional address:
Current position:
Qualifications:
Date of award bachelor degree:
Date of award of PhD:
Date and place of birth:
Nationality:
Gender:
Phone:email:
2. Host Doctoral School information
Name of the Doctoral School:
Address of the host university:
Name of the Directorof the doctoral school:
Phone:email:
Administrative contact:
Phone:email:
3. Host Laboratory
Nameof the research unit:
Hostuniversity:
Address of the research unit:
Name of the head of research unit:
Phone:email:
Name of the thesis supervisor:
Phone:email:
4. Description of the thesis
Title:
Description of the international scope:
Realised in the framework of:
Co-supervision of thesis, specify country/ Partner institution
Co-direction of thesis, specify country / Partner institution
European research project, please clarify:
International research project, please clarify:
Competitiveness cluster project, please clarify:
Former Erasmus Mundus student, please clarify:
Former Marie Curie PCRDT PhD student, please clarify:
Other, please clarify:
The present submission form shall be submitted by the newly graduated PhD holder with the following signatures:
Signature of the researcher:
SurnameFirst nameDate
Signature of the host Doctoral School Director:
SurnameFirst nameDate
Signature of the research unitDirector:
SurnameFirst nameDate
Please sign after reading the competition and rules and submission conditions.
The forms must be downloaded on the Department of International Action website from September 12th2017:
Please upload the document completed and signed together with all other documents required on the website (PDF format)
By 24th October 2017at the latest
Please include:
The application form completed and signed by the different parties
The Curriculum Vitae of the newly graduated PhD holder, including the main research work conducted (two pages maximum)
A copy of the viva voce report and the pre-thesis statement
Attestation of participation to the award ceremony
Incomplete submissions will not be taken into consideration.
1