Personal:

Male Female Sex Date of birth (DD MM YY)

Address of home institute or department:

CERN Staff Members please specify their complete CERN address. All others please specify address of your institute or department in your home country.

Name of Institute:

Department or other info (May be left blank):

Sub-department or other info (May be left blank):

P.O. Box or other info (May be left blank):

Street:

Postal Code, City:

Country:

If you are presently working at CERN, please state whether you are a:

CERN Staff Members
Fellow
Paid Scientific Associate
Unpaid Scientific Associate
Doctoral Student
Technical Student
Cooperant
Not presently working at CERN

Postal address to be used for mailing of documents:

Name of the Institute:

Department or other info (May be left blank):

Sub-department or other info (May be left blank):

P.O. Box or other info (May be left blank):

Street:

Postal Code, City:

Country
Telephone
Fax

Field of specialization:

Are you involved in High-Energy Physics? Yes No
Are you involved in any support activity linked to High-Energy Physics? Yes No
Are you involved in a CERN experiment? Yes No

Knowledge of english:

University education:

For what qualification are you working at present?

When do you expect to obtain it ?

Have you ever worked at CERN?

When? From: To:

In Which Division ?

Have you applied to attend any of the previous schools organised by CERN?

Which? Accelerator Computing Physics Of which year?

Was your application accepted or rejected ?

How did you hear about the School?

Brief description of your current work:

Other comments:

Before submitting, please remember that ...

• The submission of this completed application form should be accompanied by a letter of reference from your professor or supervisor.
• The letter of reference should reach the appropriate address specified in the section "Enquiries and Correspondence" by 15 June 2000.