Reference
Name of supervisor/professor
*
Email address of
supevisor/professor
*
Telephone number of
supervisor/professor
*
Date of letter of reference
(DD MM YYYY)
Personal
Family Name
*
First Name
*
Your e-mail address (one
only)
*
Nationality
*
Sex
Male Female
Date of birth
(DD MM YYYY)
Home Institute
Name of your Home Institute
or Department
*
Address of your Home
Institute of Department
*
Knowledge of English
Reading
Very Good Good
Fair
Writing
Very Good Good
Fair
Speaking:
Very Good Good
Fair
University Education
Institute
Locality
Attended from
Attended to
Qualifications Obtained
Present Stage of Studies
For what qualifications are
you working at present
When do you expect to obtain
it?
Past work at CERN
Have you ever worked at
CERN?
-- Yes No
If YES then, when? from...
(DD MM YYYY)
...to
(DD MM YYYY)
In which Division?
Previous Applications
Have you applied to attend any of the previous schools organised by CERN and/or JINR
-- Yes No
If so, which?
-- Physics Computer
Science
Of which year?
Was your applications
accepted?
-- Yes No
How did you hear about the School?
Mail sent from March 2009 should be addressed to...
Your Home Institute as
above?
-- Yes No
If not, specify alternative
address
Brief description of your work
Provide a 100-word description (in English) of your current work. This
will appear in the School booklet which is distributed to all participants
and include the summaries of the selected students. A sample description
is provided below:
Example: For my Ph.D. thesis I am working
on DELPHI, one of the four universal detectors operating at LEP e+e-
collider at CERN. I have performed analysis of the data collected by
DELPHI at the energies of LEP near the Z-resonance. In this analysis the
measurement of the tau-lepton polarisation through its hadronic decay
modes has been performed providing a competitive measurement of the weak
mixing angle. Now I am working on the analysis of the high energy LEP
data, measuring the fermion-pair production cross sections and
forward-backward asymmetries. From the hardware side I am engaged with the
work of monitoring the performance of the DELPHI Hadron Calorimeter and
Surround Muon Chambers. This includes development of the monitoring
software and data analysis.
Other Comments
Please indicate why you are applying, and also add other information that does not fit elsewhere in this form:
Before submitting, please remember that ...
The submission of this completed application form should be
accompanied by a letter of reference from your professor or
supervisor giving a comparison ranking with other students referred by
your professor or supervisor.
The letter should reach the appropriate address specified at the top
of this page by 21 February, 2009 .