1 – 5 June 2015
IP Paris
Phone : +33 1 44 38 94 26
Fax : +33 1 45 68 83 32
e-mail : evi.gouzelou@gmail.com
Application Form
Brief description of the LeiSHield training course
Objectives and Planned Sessions
This training course is devoted to the epidemiology of leishmaniasis. Theoretical modules will also focus on
the current molecular approaches used for Leishmania typing and for conducting population genetic
studies to assess the molecular epidemiology of the disease.
Each lecture will be followed by extensive practical modules (wet labs and/or in silico analyses) on (i)
Leishmania species identification using the HSP70 molecular tool, (ii) Multilocus sequence analysis (MLSA),
(iii) Multilocus microsatellite typing (MLMT) and data analysis, (iv) DNA bar coding of sand flies and (v)
QuantumGIS for geographical data mapping.
Debriefing oral presentations (summary of results, data interpretation and discussion, highlights and
feedback) are planned on the last day of the course (June 5th).
Purpose
The selected topics and the planned sessions for these sessions aim to extend your knowledge on
molecular typing and to provide you with the competence to utilize various typing and data analysis tools.
The major aim of this course is the transferring of this new knowledge and valuable know-how back to your
home institutes. Above this, the LeiSHield training course provides a forum to discuss about your research
project with experts in the field, to launch new collaborations and to widen your horizon on
epidemiological research.
Requirements and Selection Criteria
This is a full-time training course and your active participation is expected all through. We strongly
encourage you to interact with the other participants as well as the course instructors.
Selected applicants will be working in pairs and are expected to comply with the following levels of
experience:
1)
Your level of English is sufficient to actively participate in scientific discussions without the need for
translation.
2)
Given a SOP or the methods section from a publication, you are able to carry out a molecular
experiment such as PCRRFLP, gel analysis, and data interpretation independently.
3)
You have at least theoretical knowledge of Sanger genome sequencing and sequence alignment.
4)
You have basic knowledge on the biology, epidemiology and pathology of leishmaniasis.
2
All information given on this form is important for eligibility and selection of the candidate. Please carefully
read and fill in this form. Incomplete documents and late applications will not be considered. Completed
application form must be received no later than Friday 8th April 2015.
Course Contact: evi.gouzelou@gmail.com
Applicant personal information
Title:
First Name:
Last Name:
Gender: M  F 
Date and place of Birth:
Country of citizenship:
Authority who delivered the passport:
Passport Number:
Issuance Date (DD/MM/YYYY):
Expiry Date (DD/MM/YYYY):
Applicant contact details
e-mail(s):
Phone Number
Work:
Mobile:
Fax:
Applicant Institution details
Select which most accurately describes your position :
 Undergraduate
 MSc student
 PhD student
 Post-doc
 Other
Institute/Organization
Type
 Academic
 Government
 Industry
 Non-profit
Are you a member of the Pasteur Network?  No
Street:
Postcode:
 Yes (please specify)
3
Town:
Country:
Supervisor details
First Name:
Family Name:
Position:
e-mail(s):
Phone Number
Work:
Mobile:
Fax:
Scientific background
List the last degrees or postgraduate qualifications obtained (type, subject, university, dates)
1.
2.
3.
4.
List of publications (up to 5)
1.
2.
3.
4.
5.
Level of English Language
Please indicate your level of English
Low
Intermediate
Advanced
Proficient
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4
Relevant Experience related to course topics
Carefully estimate your experience in the following relevant topics for the course (tick X per item)
Unknown
Elementary
Intermediate
Advanced
Epidemiology of
Leishmaniasis
Basic concepts
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Projected use
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Molecular typing
methods for
species
identification
Principle
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Known Advantages
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Known Limits
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Protocol
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If applicable, please specify previous experience in the application of molecular typing tools and projected use of
the typing method(s) used
Molecular Tools:
basics
DNA sequencing by Sanger
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PCR principle
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PCR protocol
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Single- and Multi- AFLP principle
locus Analyses
AFLP protocol
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RFLP principle
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RFLP protocol
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MLSA principle
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MLSA protocol
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MLMT principle
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MLMT protocol
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DNA data analysis
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Population structure/phylogenetic analyses
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GIS analysis tools
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Multi-locus
Analysis
Bioinformatics
tools
If applicable, please specify previous use of bioinformatics tools relevant to the course topics.
5
Scientific Outline of current research topics
Please give a brief outline of your current research, focusing mainly on the topics that have a direct link to
the subjects covered by the course (limited to 300 words)
6
Motivation for attendance to this course
This section should be used to explain (within this page frame) how the knowledge and/or expertise
gained from the course will be beneficial to the attendee’s work and institution.
7
Supporting statement from supervisor
Please upload a letter of support from your direct supervisor stating why you should attend. This letter
must be signed, scanned and uploaded as a pdf file.
Do you have any special dietary requirements?
Applicant:
 I hereby certify that the statements and information given in this application form are true and correct.
I understand that the application had to be completed in full agreement with my current level of
experience.
Date:
Signature of applicant: