European Ph.D on Social Representations and Communication
5th International Summer School

Application form

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

When completed this application form should be transmitted by Internet and by fax in one signed copy by 1 April 1999 to:

Prof. Annamaria Silvana de Rosa
Università degli Studi "La Sapienza"
Facoltà di Psicologia
Via dei Marsi 78 - 00185
Rome -Italy
fax n. 0039-06-4991 7652.
email: derosa@axrma.uniroma1.it

After the application form has been filled in, you may confirm its electronic transmission by pressing the button "Send" at the end of this page. If the transmission is successful, an acknowledgement will be displayed. At this point, you can request to have your filled in application form on the screen, in order to print it, to sign it and to send it as above stated. If you forget to print the application form after the transmission, you can print an empty application form and fill in it by hand in order to send it by fax.


APPLICANT

Last name
First name
Sex (M/F)
Birth date (dd-mm-yy)
Nationality
HOME ADDRESS
Tel. no.
Fax No.
E-mail
ADDRESS FOR CORRESPONDENCE
(if different from above)
Tel. no.
Fax No.
E-mail

Typology of candidates:

I am applying for the Summer School:

as participant to the European PhD on S.R. & C. enrolled since 1996/97, 1997/98 , 1998/99*
as new candidate of the European PhD on S.R. & C. for 1999/2000*
as a self paying participant**
as already enrolled into the European PhD on S.R. & C. or in case my application as new candidate of the European PhD on S.R. & C. will be accepted, my participation into the Summer School will be supported on EU PhD or TMR budget on the condition I will regularly register respectively for the fourth, third, second year by the deadline indicated in the correspondence.

**as a self paying participant, in case my application will be accepted, I will regularly register for the Summer School by 20th of April 1999.


QUALIFICATION First university or equivalent graduation

University Graduation date Discipline Qualification Grades

Brief curriculum vitae since graduation (relevant qualification):

Scientific publications (give the references of no more than 5, your best or most recent):

Knowledge of European Languages

spoken level written level


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 EU PhD NATIONAL TUTOR or SOCRATES PARTNER (IC n° 29415-IC-1-98-1-IT ERASMUS-EPS-1) 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 applicant
Brief comments on benefit of participation from the Supervisor

My current research activity is focused on the following topic:


METHOD OF PAYMENT:

Accepted Credit Cards: Visa, American Express, Eurocard-Mastercard.

In case I will be selected, I authorize to charge the scientific fee for the partecipation into the fifth Summer School (or for the enrollment in the 1999/2000 a.y. EU PhD programme) on the credit card as below described.

No application will be considered without the following information:

Kind of Credit Card: Visa American Express Eurocard-Mastercard.

Name of the holder of the Credit Card:
Number of the Credit Card:
Expire data:
Amount of payment: the equivalent in Italian Lire of 730 EURO (bank expenses included) for the participation in the 5th Summer School
the equivalent in Italian Lire of 1000 EURO (bank expenses not included) for the enrollment in the 1999/2000 a.y. EU PhD
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.)".


PLEASE RANK ORDER THE WORKSHOP YOU WOULD LIKE TO ATTEND:
(1=highest preference; 2=next highest; 3=third preference)

A - Normative S.R., society and inter-group relations
B - Media, Communication and S.R.
C - S.R., organisations and professional socialisation