______________________________________________________ Application form: to be sent before May 19th 2014. ______________________________________________________ The following form must be filled in carefully by the candidate (the preferred file format is ascii text) and sent back by EMAIL ONLY to: enterface14@aholab.ehu.es (subject: ISCA GRANTS FOR ENTERFACE14) ++++++++++++++++++++++++ 1) The CANDIDATE Name: ...................................................... Institution: ................................................ Address: .................................................... Country: .................................................... Email address: .............................................. Telephone / FAX: ............................................ Date of Birth: .............................................. ++++++++++++++++++++++++ 2) PARTICIPATION Title of the project: ....................................... Dates of attendance: from .............. to ................. ++++++++++++++++++++++++ 3) PROVISIONAL BUDGET a) Currency: ............ b) Expenses: Accommodation fees ...... Transportation ...... Others ...... / Justification: ................. c) expected support: by ISCA (up to 500€): ...... Others (duplicate in case of multiple sources; Status: accepted, requested, etc.): Amount: ...... / Status: ....... / Origin: ........................ ++++++++++++++++++++++++ I hereby certify the authenticity of the above information. In case of more funding obtained from other sources than ISCA, I commit myself to reimburse ISCA the difference. If requested, I will make an original report on my work at the workshop and send it to ISCA within one month after the workshop. Date:....... Signature............. ++++++++++++++++++++++++ ADDITIONAL DOCUMENTS (Please, pdf files attached to the email) 1. Curriculum Vitae with academic records 2. Complete list of previous publications 3. Recommendation letter (email is acceptable) from the Director of your Laboratory Application should be sent before *May 19th 2014*. ----------------------------