Application form for a CIMPA school

Application form for a CIMPA research school

CIMPA can provide financial help for young mathematicians (generally less than 38 years old or having a recent Ph.D.) coming only from neighbouring regions of the research school. CIMPA could cover travel expenses and, if necessary, lodging.

For registration without financial support: please just fill in part A.

For financial support, please fill in carefully all fields in parts A AND B. You will need to provide a short CV by typing, pasting, or uploading a PDF file of size less than 800 Kb; please check the size of your file before starting.

If you are a lecturer or organizer of the research school, don't fill in this form, please contact directly the organizers on site.

If you are living in the country of the research school: please register with the local organizers, not with CIMPA.

Thank you not to apply for more than 4 CIMPA research schools in the same year. In case of overflow records are cleared.

PART A:

Title of the school (with deadline formatted 'YYYY/MM/DD'):

Family name:
Given name:
Birthdate (DD/MM/YYYY):
Gender:	Female Male
Nationality:

Name and address of your Institution:

Country of your institution:

Tel. in your institution: Your email:

Present position:

Main mathematical interests:

If any, mention a recent written work or publication - please give precise references:

Registration fee:

We have the opportunity to help more young mathematicians through the registration fees. If you live in a developement country and are requesting funding of CIMPA, we understand that you probably need to be exempt and this will certainly be accepted.

Please pay registration fees on CIMPA web-site:
Research Schools > Online registration Fee Payement.
In case you prefer to pay using another method, please contact CIMPA.

Please check one of the following boxes.

I am able to pay the registration fee (300 euros).

I can pay only for the registration fee.

I require to be exempted (reasons below)

Why you are unable to obtain funding for the registration fee:

Have you already participated or applied for a CIMPA school?

If so, please list title(s) and year(s) of the school(s) and mention if you have participated or just applied:

Check this box if you are not requiring any financial support from CIMPA (neither travel nor lodging). In this case, go to antispam code and send the form.

PART B:

Personal address:

Personal tel.:

Preferred mailing address?

Latest degree: Title of the diploma:

Date of the diploma:

Institution of the diploma:

Degree in preparation (if any) Title of the diploma:

Institution of the diploma:

Funding

List institutions (other than CIMPA) where you have applied for financial support concerning this research school; check the box if you have obtained support:

	Financed by	Obtained	Amount	Currency
Travel
Stay
Registration fee

Estimated cost of your travel in economy class:

What amount do you require from CIMPA for your travel (0 if you ask for nothing):

Are you requiring CIMPA to finance your stay?

If you ask CIMPA to partially finance your stay, list the amount you have already obtained, or you plan to obtain, for your stay:

Personal insurance

In any case CIMPA will not cover your health care, hospitalization and repatriation expenses. Health insurance is mandatory.

Each year CIMPA will send you its yearly programme; if you do not wish to receive it, please check here

Motivation Letter Write your motivations for attending this school (less than 3000 characters):

Curiculum vitae You can write it or paste it hereunder (less than 10000 characters):

If your CV is in a local file, please copy its content above.

You can also upload a PDF file (only PDF) by designate it hereunder (size less than 800 Kb; take care, a higher size or a non PDF file can invalidate your application):
Fichier :

Separate documents to send to CIMPA

Please send the following documents by email to CIMPA Jeanick.Allanic@unice.fr as soon as possible:

2 distinct letters of recommendation - to be sent by email to CIMPA Jeanick.Allanic@unice.fr by their authors;
1 copy of the page of your passport with your name, address and photograph;
proof of financial support you have applied or obtained from other institutions.

Antispam code, type the 3 BLACK characters

IMPORTANT: A confirmation page for your application will be displayed and then you will receive a confirmation email for your application (if you typed the right address). Otherwise contact the CIMPA technical staff