(Updated: 10/3/2015)
FORM B
END OF VISIT REPORT FOR ASSOCIATES
The information you provide below is vital for the continuation of the Scheme.
Instructions:
1. Complete the Form B below (in .doc format);
2. Prepare a separate document listing your publications from the start of your associateship (in .doc format);
3. Send your Form B and list of publications (in .doc format), in two separate documents, to your individual
scientific coordinator by email with copy to assoc@ictp.it;
4. Bring the signed, hard copy of the Form B and list of publications, in two separate documents, to the Office of
Associate & Federation Schemes
SURNAME:
First name:
Full name & address of permanent Institution :
Middle name(s):
Tel. No.:
Address:
Telefax:
E-mail address:
City:
Country:
Zip code:
Full name & address of present Institution
(if different from permanent):
Tel. No.:
Address:
Telefax:
City:
Electronic mail address:
Country:
Zip code:
Temporary address valid until:
DATE OF ARRIVAL AT ICTP:
-------------------------------------
DATE OF DEPARTURE FROM ICTP:
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Period/s spent outside ICTP in connection with present Associateship visit:
Institute/Town/Country:
Reason for visit:
Field of Research:
Kindly specify below (using a maximum of 150 characters) your current main resesarch topics:
Give a brief description of the research work carried out during your visit.
Give details of lectures and seminars given at ICTP and/or elsewhere during your visit.
List scientific activities attended at ICTP and/or elsewhere during your visit and the benefits obtained from such
activities.
List titles of papers/preprints published or submitted for publication during your visit.
Give details of scientific collaborations/contacts made during your visit.
Comment on the relevance and impact of your scientific activity at the ICTP to your scientific work in your
country.
VERY IMPORTANT
- HOW MANY REFEREED INTERNATIONAL JOURNALS/PROCEEDINGS
DID YOU HAVE AT THE START OF YOUR ASSOCIATESHIP?
N.
___________________________________________________________________________________________
- HOW MANY REFEREED INTERNATIONAL JOURNALS/PROCEEDINGS
HAVE YOU PRODUCED SINCE THE START OF YOUR ASSOCIATESHIP?
N.
____________________________________________________________________________________________
TOTAL NUMBER TO DATE
N.
Please suggest ways in which the ICTP could be of greater assistance to your future research work.
Other comments and suggestions.
Signature:
Date: