Umicore Materials Technology PhD Award 2018 –p.1of3

Umicore Materials Technology
2018 PhD Award / /
Fonds Wetenschappelijk Onderzoek – Vlaanderen
Research Foundation  Flanders
Department Scientific Prizes
Egmontstraat 5  1000 BRUSSEL
Tel. 02 550 15 31  Fax 02 512 58 90
E-mail: Website: / FWO_WP_UMICORE_2018
To be filled in by the FWO
received date
number / file

What is the purpose of this form?

With this form you can apply for the Umicore Materials Technology PhD Award 2018 that rewards an original contribution in one of the following fields:
-Materials forEmission Catalysis
-Battery Materials

How to submit this form?

This form has to be submitted at the latest on Monday, September 17,2018, throughemail at .

How does the FWO handle the data in this form?

The FWO uses your information only for processing your candidature. The data will be handled confidentially.As soon as the FWO has processed your application, you will receive a notification message.

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 / day / month / year
nationality / gender / m / v
civil status
2 /

Enter the details of your account number.

IBAN
BIC or SWIFT
3 / 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 (ddmmyyyy)
4 / Enter your present occupation along with the coordinates of the according institution/organisation.

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 materials)
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
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 FWO reserves the right to call for offprints.

Mandatory attachments

10 / 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

11 / 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 / day / month / year
signature
first name and last name