DG XII/B/1 COST Cooperation

(Revised January 1996)

 

 

 

 

 

 

 

 

SHORT-TERM SCIENTIFIC MISSIONS

 

 

 

 A P P L I C A T I O N F O R M

 

 

 

For the attention of the chairperson of the Management Committee COST Action ______ :

 

 

Please complete using a typewriter or in BLOCK CAPITALS

 

 

 

FROM

 

 

Name :

 

First Names :

 

Organisation :

 

 

 

 

Street :

 

Town and Postcode :

 

Country :

 

Telephone :

 

Telefax :

 

E-mail Address :

 

- 2 -

 

 

 

1. Description of candidate

 

1.1. I apply for the period from _____________ to ______________

 

1.2. COST Action and title:

 

Project Number or Working Group number and title (if any) :

 

 

1.3. Academic qualifications (Title, Degrees) :

 

1.4. Nationality :

 

1.5. Date of birth :

 

1.6. Present employer (if different from organisation above) :

 

 

 

 

2. Detailed Work Plan (to be attached)

 

 

3. Detailed estimation of the funding requested (to be attached)

 

Ø Amounts in ECU and national currency

Ø Amount requested from CEC : - travel costs, - subsistence allowance

Ø Indication of contribution from other sources (national and/or private)

Ø Indication of other previous CEC financial support or current requests to the CEC

(COST or other Commission activities)

 

Details of bank account :

 

 

 

 

 

 

 

5. I enclose the "Acceptance by the host institution" of the work plan duly signed.

 

I would be pleased to provide further information if requested to do so.

 

I, the undersigned, declare that the information provided above and enclosed is, to the best of my knowledge, accurate and complete.

 

 

 

Date : .......................

Signature : ..................................

 

DG XII/B/1 COST Cooperation

 

 

 

 

 

 

 

 

SHORT-TERM SCIENTIFIC MISSIONS

 

 

Acceptance by the Host Institution

This declaration is to be completed by the head of the host research group and returned to the grant applicant.

 

Please complete using a typewriter or in block capitals

 

Name :

First Names :

Organisation :

Street :

Town and Postcode :

Country :

Telephone :

Telefax :

E-mail Address :

(i) I, the undersigned _______________________________________ am willing to receive __________________________________________, in my institution on a short-term scientific mission in the frame of the COST Action _______ to undertake the work described in the attached work plan.

(ii) The duration of the request is from ______________________ to _____________________.

 

Date : ..................... Signature : ..............................