Фонд некоммерческих программ 'Династия': Интерактивная заявка для аспирантов и молодых ученых без степени (на английском)

Заявка для аспирантов и молодых ученых без степени (Eng.)

Form of Individual Fellowship Application for Postgraduate Students and Researchers without Scientific Degree

1. Scientific field*:
(indicate only one code)

	A — Astrophysics, Plasma Physics, and related topics
	B — Nuclear Physics, Elementary Particle Physics, Quantum Field Theory, String Theory and related topics
	C — Condensed Matter Physics, and related topics
	D — Other Fields of Theoretical Physics

2. Project title, keywords*:

3. Family name*:

4. First name, middle name *:

5. Date of birth*:

6. Education*:
full name of the institute, year of

7. Diploma thesis *:
title, supervisor

8. Institutional affiliation
- full name*:

9. - acronym*:

10. Position*:

11. Current support in the form of grants or fellowships*:
from Russian and international sources

12. Teaching activity
– current*:

13. – planned*:

14. List of papers
(each position in the list of scientific works begins with a new line),
– in refereed journals*:

15. – accepted for publication in refereed journals*:

16. – in non-refereed journals*:

17. – in Proceedings*:

18. Advisor*:
family name, first name, middle name, title, position, institutional affiliation, telephone and E-mail adress

19. One more scientist (Russian or foreign) who willing to write
a letter of recommendation within a four-week deadline *:
family name, first name, middle name, title, position, institutional affiliation, telephone and E-mail adress

20. Passport information*:
number, date/place of issue

21. Home mailing address *:

22. Office telephone*:

23. Home telephone*:

24. Mobile phone*:

25. Fax*:

26. E-mail address*:

27. Tax payer identification number for individuals*:

28. Scientific interests*:
Description of current research and future plans (no more than 2 pages)

Date*:
(dd.mm.year)

Signature:
(for print version)