VvE Student Award 2015 Personal information Address: Telephone

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VvE Student Award 2015
(Sent this application form, with a copy of registration to one of the universities
(maximum 1 year old) and your abstract to the Netherlands Epidemiological Society
([email protected]).
Personal information
Personal data
Name:
Address:
Telephone number:
E-mail:
Man or woman:
Birthday:
Study
University:
Study:
Main subject:
Date of graduation:
Course
Division and place:
Supervisors:
Course period :
from
to
Short description of work within internship:
Sent or e-mail to:
Vereniging voor Epidemiologie, p/a Erasmus MC, Gebouw Ae, Kamer 407,
Postbus 2040, 3000 CA Rotterdam
[email protected] - www.epidemiologie.nl
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