IEEE Industrial Electronics Society – Student Scholarship Application Form
(only for IEEE - Industrial Electronics Society students presenting paper during conference)
First Name ______________________Last Name _____________________ Age______________
Nationality______________________ University _____________________ City_______________
Country_______________________ Fax________________ email __________________________
IMPORTANT: notification of scholarship will be sent by email or fax, if you do not answer within a week
or if your email/fax is not working, the scholarship will be attributed to another student. Indicate if you
want to receive the notification by fax.
Name of conference: _______________________________________________________________
Paper Number and topic: ____________________________________________________________
Information on the course of study (check one): Undergraduate _____Master_____ PhD_____
IEEE Number: ___________
Are you a member of the Industrial Electronics Society (IES)? (yes/no)
Have you benefited of IES scholarship in the past ? ______ ,if yes, when and at which conference ?
_________________________________________________________________________________
Attachments:
1) A brief curriculum vitae (no more than one page)
2) A copy of the accepted paper
3) Certificate in English signed by the Head of Department or the Dean of the Faculty
concerning your student status.
__________________________
date and signature
IMPORTANT: if you have renewed the membership to IEEE after the 31/12/2008 or you are a new
member you have to send proof of your membership.
Send this application by mail OR e-mail to
Mariusz Malinowski
Warsaw University of Technology
Institute of Control and Industrial Electronics
Ul. Koszykowa 75, 00-662 Warsaw, Poland
e-mail malin@isep.pw.edu.pl