APPLICATION_FORM_DIOXIN_2020_STUDENT_TRAVEL_GRANT

IDENTIFICATION

Family name:

First name:

E-mail address:

Organization:

City:

Country:

PROOF OF AN ACTIVE STUDENT STATUS

->to be uploaded on the submission website

ABSTRACT/PROCEEDING FOR AN ORAL OR A POSTER PRESENTATION

->to be uploaded on the submission website

CANDIDATE RESUME (MAXIMUM 2,000 CHARACTERS) OR CV (MAXIMUM 1 PAGE)

->Resume below or CV to be uploaded on the submission website.

STATEMENT OF RESEARCH GOALS AND ACCOMPLISHMENTS BY THE APPLICANT (MAXIMUM 2,000 CHARACTERS)

AVAILABILITY AS VOLUNTEER

□ I accept to be contacted by the organizers to carry out various small logistical tasks during the congress if needed (e.g. handing the microphone during conferences…).

SUPPORTING STATEMENT BY THE APPLICANT’S RESEARCH ADVISOR

Family name:

First name:

E-mail address:

Organization:

City:

Country:

Statement:

If granted, travel aid to be should be paid to: □ Applicant □ Host organization

SIGNATURES OF BOTH APPLICANT AND ADVISOR

Documents to be uploaded on the Student Travel Grant submission page (application form, proof of an active student status and possible CV) must be downloaded as a single pdf file.