Short term fellowship form

Name: European Federation of Immunological Societies
Price range: $

Family Name

First Name

Date of Birth

Nationality

Address of Correspondence

Phone:

e-Mail:

Other:

Date MSc/PhD/MD awarded:

Intended Starting Date

Intended end of stay

Current Institute:

City

Country

Head of Group:

Host Institute:

City

Country

Head of group

Prospective Supervisor

Supervisor's phone number

Supervisor's email

Title of the proposed research project:

Have you applied for support to other sources?

YesNo

Tell us more

Have you previously received an EFIS-IL fellowship?

YesNo

Tell us more

Please upload the required documents (accepted formats: .doc and .pdf). The size of each document you upload may not exceed 700kb. Data transfer is SSL encrypted for your security and all documents are stored exceptionally and exclusively for the purposes of this application procedure.

The upload will only start after you selected a file for each field and if the files to be uploaded have the correct format and size.

Short curriculum vitae (.doc or .pdf):

List of publications (.doc or .pdf):

Project proposal (max 2 pages, .doc or .pdf) The proposal should include: - summary and aim - background - operational objectives and working plan

Letter of recommendation (not from the receiving institute, .doc or .pdf)

Acceptance letter from the head of receiving Institute (.doc or .pdf)

Proof of EFIS membership (.doc or .pdf):

* I agree that any information I enter into the online form will be stored and used to process my application. Personal data transmitted and processed for funding application purposes will be deleted from data repositories once the commitment of EFIS has been fulfilled. Please note that you can withdraw your consent at any time by sending an email to office@efis.org. More information on our use of data can be found in our privacy policy.

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