Registration Form for Potential Assessors of Major
Project proposals
Operational Programme Research, Development and
Education
1. Surname, Name, Titles
2. Contact Details
Please fill in here
E-mail
Telephone
Mobile Number
Correspondence Address
3. Are you Self-Employed?
YES ☐
NO ☐
If YES, please go directly to point 5.
4. Name and Address of Current Employer/Employers
5. Programmes in which you have previously conducted assessments or evaluations
(state Programme Names and Countries they are implemented by)
6. Experience of the Assessor in the area of Assessment and/or
Evaluation of RDI interventions
Please state
number of years
of relevant
experience
Experience of managing a research centre/institute i.e. holding a
position in senior or middle management of such a centre
Experience with the assessment/evaluation of R&D projects and/or
experience with the assessment/evaluation of research organisations
7. Specific Experience in Related Scientific Fields
A. Humanities & Social sciences
1. Philosophy & Religion
2. History
3. Archeology, Anthropology, Ethnology
4. Politology & Political Sciences
5. Management & Administration
6. Documentation, Librarianship, Information Studies
7. Legal Sciences
8. Economics
9. Linguistics
10. Letters, Mass-media, Audiovision
11. Sport & Free-time Activities
12. Art, Architecture, Cultural Heritage
13. Education
14. Psychology
15. Sociology, Demography
16. Urban, Regional and Transport Planning
17. Safety, Health Protection, Human - Machine
B. Physics & Mathematics
Please state
number of years
of relevant
experience
1. General Mathematics
2. Applied Statistics, Operational Research
3. Control Systems Theory
4. Theory of Information
5. Theoretical Physics
6. Elementary Particles and High Energy Physics
7. Nuclear, Atomic and Molecular Physics, Colliders
8. Optics, Masers, Lasers
9. Acoustics
10. Thermodynamics
11. Fluid Dynamics
12. Plasma and Gas Discharge Physics
13. Solid Matter Physics & Magnetism
14. Astronomy, Celestial Mechanics, Astrophysics
15. Biophysics
C. Chemistry
1. Inorganic Chemistry
2. Analytical Chemistry, Separation
3. Organic Chemistry
4. Macromolecular Chemistry
5. Biochemistry
6. Physical & Theoretical Chemistry
7. Electrochemistry
8. Nuclear & Quantum Chemistry
9. Industrial Chemistry, Chemical Engineering
D. Earth Science
1. Hydrology & Limnology
2. Geology & Mineralogy
3. Siesmology, Volcanology, Earth Structure
4. Geochemistry
5. Earth Magnetism, Geodesy, Geography
6. Soil Science
7. Athmosphere Sciences, Meteorology
8. Mining, incl. Coal Mining
9. Air Pollution & Quality
10. Water Pollution & Quality
11. Soil Contamination & De-contamination incl. Pesticides
12. Nuclear Waste, Radioactive Pollution & Quality
13. Solid Waste and Recycling
14. Health Impact of the Environment Quality
15. Wilderness Conservation
E. Bioscience
1. Cell Biology
2. Genetics & Molecular Biology
3. Immunology
4. Physiology
5. Microbiology, Virology
6. Botanics
7. Zoology
8. Ecology, Behaviour
9. Biotechnology & Bionics
F. Medicine
1. Cardiovascular Diseases incl. Cardiotharic Surgery
2. Endocrinology, Diabetology, Metabolism, Nutrition
3. Pulmology
4. Oncology & Hematology
5. Other Internal Medicine Disciplines
6. HEENT, Dentistry
7. Pediatrics
8. Neurology
9. Traumatology, Orthopedics
10. Surgery incl. Transplants
11. Gynaecology, Childbirth
12. Psychiatry, Sexuology
13. Hygiene
14. Epidemiology, Contagious Diseases & Clinical Immunology
15. Dermatovenerology
16. Other Medical Disciplines
17. Public Health Care, Social Medicine
18. Pharmacology & Medidal Chemistry
19. Medical Facilities & Equipment
G. Agricultural Science
1. Agricultural Economics
2. Machines & Buildings for Agriculture
3. Agronomy
4. Fertilization, Irrigation, Soil Processing
5. Plant Breeding
6. Plant Pathology, Vermin, Weed, Plant Protection
7. Livestock Rearing
8. Livestock Nutrition
9. Animal Husbandry & Breeding
10. Animal Vermins & Diseases, Veterinary Medicine
11. Forestry
12. Fishing
13. Food Processing
14. Informatics, Computer Science
J. Industry
1. Electronics & Optoelectronics, Electrical Engineering
2. Sensors, Measurment, Regulation
3. Computer Hardware & Software
4. Computer Applications, Robotics
5. Non-nuclear Energetics, Energy Consumption & Use
6. Nuclear Energetics
7. Metallurgy
8. Ceramics, Fire-Resistant Materials and Glass
9. Composite Materials
10. Other Materials
11. Corrosion & Surface Treatment of Materials
12. Materials Fatigue, Friction Mechanics
13. Building Engineering
14. Civil Engineering
15. Structural Engineering
16. Industrial Processing
17. Machines & Tools
18. Other Machinery
19. Reliability & Quality Management, Testing
20. Propulsion, Motors & Fuels
21. Aeronautics, Aerodynamics, Aircrafts
22. Space Technology
23. Navigation, Links, Detection & Counter-Measures
24. Fire-Arms, Ammunition, Explosives, Fighting Vehicles
K. Military Science
1. Military Science
8. Requirements for Assessors
Do you fulfil the requirements and criteria stated in the call for experts
on our web-site?
If so, which ones?
Tick for YES
☐
☐ I. (both)
☐ II. 1.
☐ II. 2.
☐ II. 3. a.
☐ II. 3. b.
9. Availability
Are you available within 12th to 28th December 2014 to perform the task
given and submitt an assessment (work from home)?
☐
Are you available and willing to attend a meeting in Prague on 5th
January 2015?
☐
10. Conflict of interest
Are you aware or have you got any connection, contract, co-operation
agreement to any of the major project applicants or do you feel you
might have any conflict of interest in this matter?
If so, please state the details:
☐
11. CV
Is your current CV attached?
☐
12. Sworn statement
I acknowledge that this declaration and attached CV are true and correct, and I make it with the
understanding and belief that a person who makes a false declaration is liable to the consequences
of such action.
In …………………………………
On ………………………………
Name: …………………………………………………
Signature: …………………………………………..