Tel.: 39 40 2240552
Fax: 39 40 22407552
[email protected]
REQUEST FOR A GRANT
UNDER THE AGREEMENT BETWEEN
THE KUWAIT FOUNDATION FOR THE ADVANCEMENT OF SCIENCES
AND
THE ABDUS SALAM INTERNATIONAL CENTRE FOR THEORETICAL PHYSICS
INSTRUCTIONS
Two copies of this form must be completed by those scientists from Arab and Islamic countries applying
to visit the ICTP supported by a grant from the Kuwait Foundation for the Advancement of Sciences
(KFAS).
One completed form should be sent by email to the Abdus Salam International Centre for Theoretical
Physics at [email protected] and the other should be forwarded to the Director General of the Kuwait
Foundation for the Advancement of Sciences, Kuwait, at [email protected]
Please note that:
- A recent photograph of the candidate must be attached.
- Each question must be answered clearly and completely.
- If more space is required (for the list of publications, for example), additional pages may be attached.
Request for a Grant under the
Kuwait Foundation for the Advancement of Sciences
Family Name:
Other Names:
Maiden Name:
(For women)
Sex: M / F
Date of Birth:
Please attach
Present Nationality:
a recent photo
Nationality at Birth:
Place of Birth (City & Country):
Marital Status:
Number of Children:
Full Name and Address of Permanent Institute:
Telephone:
Name & Address:
Fax:
City:
E-Mail:
Post Code:
Country:
Full Name and Address of Present Institute:
Telephone:
(IF DIFFERENT FROM PERMANENT INSTITUTE!)
Name & Address:
Fax:
City:
Post Code:
E-Mail:
Country:
Address Valid Until:
Home Address:
Telephone:
Fax:
City:
E-Mail:
Post Code:
Country:
Mailing Address: Permanent:
Present:
Home:
ICTP activity relevant to your work which you are interested in joining (indicate SMR
no):
Expected arrival date:
Expected departure date:
EDUCATION (Higher Degrees - start with last Institute attended)
Name of Institute
Dates Attended
Qualification Obtained
Participation in Seminars, Summer schools, Conferences etc.
Name & Place
Year
Have you participated in past ICTP activities? YES / NO If Yes, which?
SCIENTIFIC EMPLOYMENT AND ACADEMIC RESPONSIBILITY
Name of Institute
Period of Service
Duties
Describe your present employment and duties, stating also any position you
hold in the scientific administration of your institute.
Give a brief account of your work, its highlights and your present research
problems.
Please give details of any scientific society or professional organization of
which you are or have been a member.
Name of Organization
Your Function
3/5
Request for a Grant under the
Kuwait Foundation for the Advancement of Sciences
FIELD OF INTEREST
PLEASE UNDERLINE YOUR PRIMARY FIELD OF INTEREST ONLY AND INDICATE UP TO FOUR
OTHER FIELDS WITH A CROSS (X).
10.PHYSICS OF CONDENSED MATTER
11. Solid State Physics
12. Atomic, Molecular
13. Materials Science
14. Surfaces and Interfaces
15. Statistical Physics
16. Computational Physics in Condensed Matter
20.PHYSICS OF HIGH AND INTERMEDIATE ENERGIES
21. High Energy and Particle Physics
22. Relativity, Cosmology and Astrophysics
23. Plasma Physics
24. Nuclear Physics
30.MATHEMATICS
31. Applicable Mathematics including:
Mathematical Ecology,
Systems Analysis,
Mathematics of Developments,
Mathematics in Industry
33. Algebra
34. Geometry
35. Topology
36. Differential Equations
37. Analysis
38. Mathematical Physics
40.PHYSICS AND ENERGY
43. Non-Conventional Energy (Solar,
Wind and others)
50.PHYSICS OF THE ENVIRONMENT
51. Geophysics
52. Soil Physics
53. Climatology and Meteorology
80.MISCELLANEOUS
82. Digital Communications and
Computer Networking
90.PHYSICS OF THE
91. Neurophysics
92. Biophysics
93. Medical Physics
LIVING STATE
AO.APPLIED PHYSICS
A2. Microelectronics
A5. Synchrotron Radiation
A7. Lasers
SPECIFY YOUR MAIN RESEARCH TOPICS USING A MAXIMUM OF 150 CHARACTERS:
P u b l i c a t i o n s
Title 1
Author/s
Reference
Title 2
Author/s
Reference
Title 3
Author/s
Reference
Title 4
Author/s
Reference
Title 5
Author/s
Reference
List foreign research institutes visited.
Host Institute
Duration of visit
Purpose of visit
LANGUAGES
What is your mother tongue?
Indicate your proficiency in English:
Reading
Writing
Speaking
Fair
Good
Excellent
Name & Address of person to contact in case of emergency - Relationship:
Telephone:
Telefax:
E-Mail:
I certify that the statements made by me above are true and complete.
If
selected, I undertake to refrain from engaging in any political or other
activities which would reflect unfavourably on the international status of the
Abdus Salam International Centre for Theoretical Physics. I understand that
any breach of this undertaking may result in the termination of the
arrangements relating to my visits to the Centre.
I agree that my email address and
WWW.ICTP.IT page if I am accepted.
Yes
❐
photograph may be
made public on
the
No
❐
______________________
Signature of candidate
___________________
Place
5/5
_________________
Date