European Ph.D on Social Representations and Communication
3th International Summer School

Application form

Note: submission is no more possible as the deadline has expired.

This application form, including a brief comment signed by a Tutor, should be returned both in two copies by mail and one copy by fax or e-mail by 20 of April 1997 to:

Prof. Annamaria Silvana de Rosa
Università degli studi di Roma 'La Sapienza'
Facoltà di Psicologia
Via dei Marsi, 78 - 00185 Roma ITALIA
fax: +39 - 6 - 4991.7652
E-mail: derosa@axrma.uniroma1.it

Surname:
First name and Initials
Male Female
Home address
Address for
correspondance
E-mail
Date of birth
Nationality

Typology of candidates

I am applying for the Summer School:

as participant to the European PhD on S.R. & C. enrolled since 1996 *

as new candidate of the European PhD on S.R. & C. *

as a self-paying participant **

* as enrolled into the European PhD or in case my application as candidate of the European PhD on S.R. & C. is accepted, my participation to the Summer School will be supported on Erasmus or T.M.R. budget, on the condition I will regularly register respectively for the second/first year of the Euro PhD by 31 May 1997
** as a self-paying participant, in case my application is accepted, I will regularly register for the Summer School by 31 May 1997 with or without the support of T.M.R. funding.

Qualification (First University or equivalent graduation)

University
Graduation date
Discipline
Qualification
Grades

Brief curriculum vitae since graduation (relevant qualification)

Scientific publication

Knowledge of European languages

References (please include a brief comment signed by the person below indicated):

Name and Institution of a person to whom reference may be made about your suitability to pursue the Summer School. The person should be a Euro PhD NATIONAL TUTOR or ERASMUS ICP I-96-3074/14 PARTNER or, in any case, a senior member of the staff of the respective University, Polytechnic or College which you attended (e.g. Tutor of Doctoral Programme, Head of Department, Professor).

Name
University
Relation with
appplicant
Brief comment
from the Supervisor
Supervisor code

Would you like to present your current research activity during the afternoon session even if you aren't Euro PhD student ?

If yes, please indicate the topic of your presentation:

Topic :
What I need : slide projector
overhead projector
video-tape projector
Please fill in the estimated costs of travel to the event (using the most economical air or second class train fare) and the full references of a travel agency (or air company) to be eventually contacted in your country for a prepaid ticket.

Estimated costs of travel to the event

From
To
Type
Cost
Cost in ECU
Travel agency or
company to be
contacted

Declaration:

I declare the above truthful and sincere. I also declare that if awarded a grant by the organisers of the event, I will not cover any expenses from more than one funding source, in agreement with the T.M.R. rules which state:

"The selected researchers may not benefit, for any given expense in connection with participation, from TMR funding at the same time as from any other source. It is however allowable for different expenses to be funded from different sources (e.g. registration fees from one source and travel from T.M.R.)".