Application for ASCI students wishing to attend the
1996 CERN School of Computing, Egmond aan Zee, The Netherlands
                    8 - 21 September 1996


FAMILY NAME: .................................................
(in capitals)
FIRST NAME:  .................................................
(Underline name to be used for badge)
DATE OF BIRTH:................................................
SEX:  - M .....  - F .....
NATIONALITY: .................................................

WANTS TO ATTEND:
-  The first week .....
-  Both weeks     ..... (only for a limited number of persons)

ADDRESS OF HOME INSTITUTE OR DEPARTMENT:
..............................................................
..............................................................
..............................................................
E-MAIL ADDRESS: ..............................................

FIELD OF SPECIALIZATION:
-  Computing       ...........................................
-  Imaging         ...........................................
-  Other (specify) ...........................................

UNIVERSITY EDUCATION:
-  Institute: ................................................
-  Locality:  ................................................
-  Attended: From ..............  To .........................
-  Qualifications obtained:  .................................
   Present stage of studies: .................................

FOR WHAT QUALIFICATION ARE YOU WORKING AT PRESENT?............
..............................................................
WHEN DO YOU EXPECT TO OBTAIN IT? .............................

HAVE YOU APPLIED TO ATTEND ANY OF THE PREVIOUS SCHOOLS
ORGANISED BY CERN?
- If so, which?  - Computing .....   - Physics .....
- Which year? ....................
- Was your application accepted ..... or rejected .....?

PLEASE STATE WHETHER MAIL DISPATCHED BETWEEN MAY AND AUGUST
1996 SHOULD BE ADDRESSED TO:
- Your home institute as above ...............................
- or other ...................................................

Date: .............         Signature: .......................



--------------------------------------------------------------
Notes:

1. Please complete this application form and prepare a
   100-word description of your current work and indicate the
   computer(s) and programming language(s) with which you are
   familiar. Please note that we would like this description
   to be sent by e-mail to the following address:

   Bureau ASCI
   Faculty TWI
   TU Delft
   P.O. Box 356
   2600 AJ  Delft
   The Netherlands

   Email: asci@twi.tudelft.nl
   Fax:   +31 15 278 7141

2. If you want to attend the second week, please include a
   motivation why this would be relevant to your research.

3. CLOSING DATE. Applications must reach the above address at
   the latest by 31 May 1996. Applications received after
   this date will not be considered.