form - InGRID

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Application form –TNA InGRID
Personal information
Title (e.g. prof./dr./mr/mrs/…)
First name
Last name
Nationality
Gender (e.g. male/female)
Address of residence
(e.g. Parkstraat 47 box 5300, BE-3000 Leuven)
Country of residence
Job title (e.g. research assistant, …)
Name of institute/organisation
Address of institute/organization
(e.g. Parkstraat 47 box 5300, BE-3000 Leuven,
Belgium))
Email
Phone (e.g. +32-16-323333)
Research expertise
Home institution type
UNI = university and other higher education organisations
RES = public research organisation (including international
research organisations as well as private research
organisations controlled by a public authority)
SME = small or medium enterprise
PRV = other industrial and/or profit private organisation
OTH = other organisation not fitting in one of the above
categories
University degree (e.g. Master in Sociology,
(Degree Title; date of award)
1992)
Doctorate (e.g. Doctor in the Sociology, 1992)
(Degree title, date of award)
Fields of expertise/topics of interest
Research experience
UND = undergraduate
PGR = post-graduate (student with a first University degree
or equivalent),
PDOC = post-doctoral researcher
TEC = technician
EXP = experienced researcher
OTH = other
Short list of relevant and recent publications
(for ex. Van Gyes G. (2012), Indicators of collectively-agreed
(max. 3)
wages in the Eurozone. A quality report. Policy paper CAWIE
project, HIVA-KU Leuven, Leuven.)
Research infrastructure to visit
Research infrastructure
HIVA-KU Leuven
TARKI-POLC
AIAS
SOFI
IECM
ISER
BIGSSS
CEE
UNIPI-DEM
S3RI
Duration (e.g. 15 working days)
Proposed period (e.g. 15/08/2013-30/08/2013)
Travelling with children
Yes
No
Single visit or group visit
Single visit
Group visit, together with…
In case of a group visit: I will visit the research
Please add the name(s) of the other team members and
infrastructure together with …
institute name(s) if different from your own institute
New user
Yes
Have you already visited an InGRID research
No
infrastructure?
Project of the visit
Short description of project/proposal (max.
300 words)
Title of project (with acronym)
Main scientific field (e.g. social sciences,
humanities, …)
Specific disciplines (e.g. psychology,
economics, …)
Main goals of visit (max. 300 words)
Expected scientific contribution (max. 300
words)
Proposed output and dissemination activities
(e.g. working paper, conference presentation,
publications, …)
Which data are required and how will they be
used? (max. 750 words)
If you are planning to link data from different
sources: please provide the following
information:
- Which data sources will be linked?
- On which level do you propose to link data
(e.g. individual respondent level or
geographical level, like NUTS2)
- indicate the intended methods for combining
data (linking, matching etc.)
Other
Upload your cv (including a list of relevant
Preferably in pdf format
publications)
How did you find out about the call? (e.g. via
the InGRID website, via InGRID mail
communication, via a colleague, …)
Additional remarks
By completing this registration form you agree with the terms and conditions for Transnational Access
within the InGRID project
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