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.) from neighbouring regions of the research school. Financial support can cover travel expenses and if necessary, lodging.

In case you apply for financial support, please fill in carefully all fields in parts A and B. Otherwise consider only part A.

In case you are a lecturer of the research school, you don't need to fill this form, please contact directly the organizers.

PART A:

Title of the school:

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

Name and address 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:

CIMPA financial resources are limited. We are able to help more young mathematicians through registration fees, you are required to obtain funding to pay them as a direct and efficient way to support CIMPA's work. If you are requiring financial help from CIMPA we understand that probably you will require to be exempted.

Please consider to check the following box.

I am able to pay the registration fee (300 euros) and I will send this amount to CIMPA in case my application is accepted.
Société Générale - Nice Cimiez Sud39 T, Boulevard de Cimiez, F-06000 Nice
IBAN : FR76 3000 3015 0800 0372 6019 317
BIC : SOGEFRPP

Otherwise, please indicate the amount you can pay for registration fee, if you require to be exempted, or why you are unable to obtain funding for the registration fee.

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:

Curiculum vitae (you can either copy and paste it below, or send a pdf to Jeanick.Allanic@unice.fr by email; in this case, write below "CV sent to CIMPA by email"):

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