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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.


Other comments:

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


Before submitting, please remember that ...



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Text: Jackie Turner Katerina Zachariadou
Web: Ioannis Sakelliou
Last update: 1 March 2000

Application Form