Formulier 2018 - Fonds Wetenschappelijk Onderzoek



3362960176530Application for the scientific awardMcKinsey & Company 2020Research Foundation – FlandersEgmontstraat 5 - B-1000 BRUSSELSTel. 02 512 91 10 - Fax 02 512 58 90E-mail: FORMTEXT prijzen@fwo.beWebsite: FORMTEXT be filled in by FWODate of receipt:NumberFileWhat is the purpose of this form?With this form you can compete for the scientific award McKinsey & Company 2020.How to submit this form?This form has to be submitted on April 30, 2020 at the latest using the e-mail address on top of this document.How does the FWO handle the data in this form?The FWO uses your information only for processing your candidature. The data will be handled confidentially and will not be disclosed to third parties. As soon as the FWO has processed your application, you will receive a notification message.Details of the candidate1Enter your personal details.First and last name FORMTEXT ?????Legal home address FORMTEXT ????? FORMTEXT ?????Private phone FORMTEXT ?????Work address FORMTEXT ????? FORMTEXT ?????Work phone FORMTEXT ?????e-mail FORMTEXT ?????Place of birth FORMTEXT ?????Date of birthDD FORMTEXT ? FORMTEXT ?MM FORMTEXT ? FORMTEXT ?YYYY FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ?Gender FORMCHECKBOX m FORMCHECKBOX fNationality FORMTEXT ?????2University degrees.Name of the degreeInstitutionDate (DD-MM-YYYY) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3Your present occupation on April 30, 2020 and the host institution of this occupation. FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Details of your PhD4Research group where you have done your PhD research:Name research group FORMTEXT ?????Head of research group FORMTEXT ?????5Describe the specific domain and/or discipline of your research in 3-5 keywords. FORMTEXT ?????6Title of your PhD thesis in English: FORMTEXT ????? FORMTEXT ?????7Name of your PhD supervisor and date of public defense:Supervisor FORMTEXT ?????Date of defenseDD FORMTEXT ? FORMTEXT ?MM FORMTEXT ? FORMTEXT ?YYYY FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ?8Give a “layman’s terms” summary of your PhD research.Maximum 1 page A4, in English. FORMTEXT ?????9Highlight the societal and/or economical relevance or the potential for implementation of your work. What is the added value of your research to society/economy/your research domain? Why does your work deserve this award? Maximum 1 page A4, in English. FORMTEXT ?????10Give a scientific presentation of the PhD research you want to submit for this award.Maximum 3 pages A4, in English. FORMTEXT ?????Publications11Please list your scientific publications in the context of your PhD research:For each publication mention the following information:titlejournal or book seriesdate of publicationpages (from-to)all names of authors, in the order in which they appear on the official publication; do not use ‘et al.’Journal’s impact factorNumber of citationsThe FWO may request a copy of one or more publications FORMTEXT ?????Other awards12Have you already received other national or international awards/prizes for this same research as submitted for this McKinsey & Company award? FORMCHECKBOX YES FORMCHECKBOX NO13If yes, please list below all awards or prizes received and the prize money for eachAward/PrizeDateAmountRewards(PhD, publication, presentation,….)Granting body FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????euro FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????euro FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????euro FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????euro FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????euro FORMTEXT ????? FORMTEXT ?????Additional documents14Please add the following documents with your application:- a full and detailed CV- an electronic copy of your PhD thesis (preferably PDF or compatible)Signature15Fill in the following statement:I confirm that any information on this form has been completed truthfully.Date DD FORMTEXT ? FORMTEXT ?MM FORMTEXT ? FORMTEXT ?YYYY FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ?Signature FORMTEXT ?????First and last name FORMTEXT ????? ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download