Application form

(1)

Personal data Thesis topic:

Surname: First name:

Date of birth Place of birth

Nationality:

Email address: Phone number:

Are you already enrolled in a PhD? Yes No

Date of the enrolment in a thesis:

Do you apply for a ¹: 2-year fellowship 3 year-fellowship

1 See the « Eligibility » section of the call

(2)

Surname: First name:

Department/unit: Rank:

University Phone number:

Email address:

If possible, what is your opinion on the quality and state of progress of the master thesis and on the PhD thesis proposal?

Research proposal:

(3)

Title of the Research Laboratory: Address:

Head of the Research Laboratory:

Phone number: Email address:

Umbrella body(-ies) of the Research Unit:

How will the PhD student contribute to the Labex’s activities:

Title of the Research Laboratory: Address:

Head of the Graduate Program:

Phone Number: Email address:

Institutions involved in the Graduate Program:

Opinion of the Graduate Program

(4)

Is your thesis co supervised? Yes No

Title of the foreign university:

Address:

Name of the co-supervisor:

Email address: Phone number:

Date

Signature of the Applicant Signature of the PhD Supervisor

Signature of the Head of the Host Laboratory Signature of the Head of the Graduate Program