Application to Support for Training in Research

Fill in the form below with your favorite text editor. The final document with no more than 3 pages has to
be converted to a pdf file and sent, along with a personal letter of invitation (to the teacher) from the host
institution and a CV of the teacher (both in pdf format), to app*cimpa.info (where * has to be replaced by
@).

I. Host Institution
Country:
Town:
Name and address of the host institution (university ou equivalent):

Name and address of the host department or laboratory:

Name and first name (in this order) of the director of the host department or lab:

Email address of the director of the host department or lab:

Name and firstname (in this order) of the local applicant (that is the person from the host institution in
charge of the application, if this person is the director named above please fill in again):

Email address of the local applicant:

II. Course
Title:
Duration: Give here the total number of hours of the course.
Number of expected attendees (students, PhD students or researchers):
Level (Master or doctorate):
Context: Explain here what is the context for this course. For example, if the course will be given as a
Master course, give some details on the Master (numbers of courses, number of students).
Perspectives: Explain what are the expected outputs of the course for the attendees and the local
environment.

III. Teacher
Name:
Firstname:
Position (Professor, assistant professor, ) :
Institution:
Country:
Town:
Email address:

IV. Mission and funding

Duration of the mission:
Dates of stay:
Amount requested from CIMPA for travel (visa included):
Amount requested from CIMPA for local expenses (housing, food)*:
Other anticipated funding:

V. Additional remarks (optional)

You can add here comments or remarks to support your application.

* Note that it is highly desirable that the host institution covers the local expenses. The CIMPA will cover
these costs only in exceptional circumstances.