Zoeken

Registration form membership PhD students

Personal date

Surname:
First Name:
Full Initials:
Academic Title:
Date of birth: (DD-MM-YYYY)
Place of birth:
Country of birth:
Gender: female male

Address

University:
Faculty/Institute:
Department:
Address:
Zip code:
City:
E-mail:
Phone:
Fax:

Participation in ICO theme group:

Theme group:

Research project:

Dutch title:
English title:
Supervisor(s):
Starting date: (DD-MM-YYYY)
End date: (DD-MM-YYYY)
Appointment: fte (full time equivalent)
Project description (max. 80 words):