| Family
Name |
** |
| First
Name |
** |
| Affiliation |
** |
| Mailing
Address: |
|
| Department |
|
| Street |
|
| City |
|
| Country |
|
| Zip/Cap Code |
|
| Telephone (including country
code) |
|
| Email address |
** |
Financial
support
(Some limited support will be
available for lodging) |
no
financial support
needed
request
support
partecipation
depends on receipt of above support |
| Academic
accomplishments: |
|
| Degree (level
and topic) |
** |
| Master
thesis: |
|
| Title |
|
| Advisor |
|
| Year |
|
| PhD
thesis: |
|
| Title |
|
| Advisor |
|
| Year |
|
|
|
| Letter
of
recommendation |
|
Each
applicant must provide a brief letter
of recommendation before the
application will be considered.
Please ask a senior collegue or
advisor
to send such a letter by email to Liliana.Superchi@unipr.it
until the deadline for
the application. |
|
|
| Research
interests
(select one or more) |
Cosmology
Standard
Model QCD Phenomenology
Beyond
the Standard Model
String
Theory
Other
|
| Your
expected
benefits from attending the school |
|
|
|
|
| I will
arrive ( MM / DD / YYYY ) |
|
| I will
leave ( MM / DD
/ YYYY ) |
|
| Additional
information |
|
| |
Contact
adress:
Liliana Superchi (Liliana.Superchi@fis.unipr.it)
Dipartimento di Fisica
Via Usberti 7/a - 43124 Parma
tel: (39) 0521 90 5259
fax: (39) 0521 90
5223 |
|