JUAS-application

JUAS 2011		*affix photo*
Joint Universities Accelerator School

European Scientific Institute
Centre Universitaire
F-74166 Archamps (FRANCE)

Tel: +33 (0) 450 315 003
Fax: +33 (0) 450 953 801
e-mail: juas@esi.cur-archamps.fr

APPLICATION FORM

Please write in BLOCK CAPITALS * Please circle as appropriate

Course selected (tick as appropriate)

O Course 1 : 3 Jan - 5 Feb 2011                                      ACCELERATOR PHYSICS
O Course 1 : Lectures selected on the programme sheet
O Course 2 : 7 Feb - 11 Mar 2011             ACCELERATOR TECHNOLOGIES AND APPLICATIONS
O Course 2 : Lectures selected on the programme sheet
O   I wish to apply for financial support

Personal details

Family name ................................................................................................... Sex : M* / F* .................................................
First Name ......................................................................................   Year of Birth     ..............................................................
Nationality (passport). ...............................................................................................................................................................
Home University / Institute..........................................................................................................................................................
(successful candidates will receive a number of letters and electronic mails : make sure mailing and electronic addresses remain valid. Please indicate overleaf or on a separate sheet alternative address(es) with dates if known. )
Mailing Address .......................................................................................................................................................................
....................................................................................................................................................................................................
....................................................................................................................................................................................................
....................................................................................................................................................................................................
e-mail address ?......................................................................................................................................................................
Telephone ................................................................................... Fax ?................................................................???....

Educational / professional background

Are you a : full-time student* / professional* / other* ...............................................................................................................
Highest relevant academic qualification to date .......................................................................................................................
Field of specialisation .................................................................................................................................................................
Date when expected to achieve this qualification .............................................................................................................?...
Name & address of your current University* / Institute* / Employer
.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
Tel. ...................................................................................................... Fax ..................................................................................
Your status / position ..................................................................................................................................................................

Knowledge of English (tick as appropriate)

        oral                      fair O                            good O                                   fluent O written                 fair O                               good O                                   fluent O

Accommodation (tick as appropriate)
      O      I would like a one-bed studio apartment in the Grand Angle Residence
      O      I would like to share a 2 or 3-room apartment in the Grand Angle Residence
                I shall be sharing with Mr./ Ms. ...................................................................................................................................
        I would like to share with someone .......from my own country* .......from a different country*       O      I prefer to stay at the two-star Hotel Ibis
      O       I shall make my own arrangements for accommodation

I first heard of JUAS through (tick as appropriate)

       O poster           O lecturer/management staff            O former JUAS students            O the web

Applicants should attach to this form a CV and a brief letter explaining their motivation and how they feel JUAS will help them in their career.

All applications must be supported by an independent reference. An academic/professional supervisor should complete the attached reference form and return it separately to the secretariat by post.