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Academic year: 2022

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(1)

PhD fellowships 2014-2017:

Application form

Personal data

Thesis topic:

Surname: First name:

Date of birth: Place of birth:

Nationality:

Email address: Phone number:

(2)

PhD Supervisor/Mentor

Surname: First Name:

Department/unit : Rank:

University: Phone number:

Email address:

To the supervisor:

If possible, what is your opinion on the quality and state of progress of the master thesis (if progress)?

Research proposal:

(3)

Host laboratory (PhD supervisor’s laboratory)

Title of the Research Laboratory: Address:

Head of the Research Laboratory:

Phone number: Email address:

Umbrella body(-ies) of the Research Unit:

To the Head of the Research Laboratory

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

Graduate Program

Title of the Graduate Program : Address:

Head of the Graduate Program :

Phone number: Email address:

Institutions involved in the Graduate Program :

To the Head of the Graduate Program

Opinion of the Graduate Program

(4)

Co Supervision

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

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