CSC 2001 WWW application form

 

 

Personal:

Title (Mr, Mrs, Miss, ... )
Family name
First name
Name to be used for badge
Your e-mail address
Nationality

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:

Computing Science
High Energy Physics
Other

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:

Reading: Writing: Speaking:

 

University education:

Institute
Locality
From: To: Attended
Qualifications Obtained
Present Stage Of Studies

For what qualification are you working at present?

When do you expect to obtain it ?

 

Have you ever worked at CERN?

No.
Yes. If so:
When? From: To:
In Which Division ?

 

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

No.
Yes. If so:
Which? Of which year?
Was your application accepted or rejected ?

 

How did you hear about the School?

First announcement
Poster
E-mail
World-Wide Web
Via a colleague
Via your supervisor
Other

 

Brief description of your current work:

Provide a 100-word description of your current work and indicate the computer(s) and programming language(s) with which you are familiar. A sample description is provided in Example of summary, above.

 

Other comments:

Please add below any information that does not fit anywhere else in this form:

 

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 at the top of this page by 30  May 2001.


all information typed in.