Application Form for Participation

To apply:

Fill in (in english) and submit this form between 5^th March and 15^th April 2007 by

- email as attached file to: 4summerschool@utef.cvut.cz

- fax to: +420 224 359 392

Personal Data

First Name:

Last Name:

Email:

Citizenship:

Gender:

Year and Country of Birth:

Home Institute

Name of your Home Institute and University Department:

Address of your Home Institute/Department (post address, telephone, fax, website):

University Education

Institute (University):

City:

Study Program:

Specialization:

Studies attended from/to:

Degree obtained:

Current stage (year) of studies:

Degree are you studying at present:

Date you expect to obtain it:

Brief description of your work

Provide a brief (100-word) description of your current scientific work:

Knowledge of English

Reading/Writing/Speaking:

Talk (Poster) and paper

Do you want to present a short talk (or poster)?

If yes, what title?

If yes, can you write a short paper (1-2 pages) for the school proceedings?

Do you prefer to give a short talk or present a poster?

Reference

Can you provide a reference?

If yes, name of supervisor/professor:

Institution

Email address of supevisor/professor

Telephone number of supervisor/professor

Previous Applications

Have you attended any of these previous schools?

If yes, which (year)?

Visa

Do you need a Czech Visa?

If yes, Passport Number:

Passport expiration date

You may be requested to send us a scanned copy of your passport.

Which topics and subjects you find most attractive in this School?

Comments and suggestions

Date of application: