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27100 Pavia - ITALY - Human Development and Capability Association ()

By Kyle Ellis,2014-06-20 00:32
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27100 Pavia - ITALY - Human Development and Capability Association ()

    CICOPS CICOPS NIVERSITÀ DEGLI TUDI DI AVIA SP NIVERSITÀ DEGLI STUDI DI PAVIA UUCentre for International Cooperation & Development Corso Strada Nuova, 65 Tel +39 0382.984241/4232 27100 Pavia ITALY Fax +39 0382.984092 P.Iva 00462870189 ? C.F. 80007270186 cicops@unipv.it

     CICOPS SCHOLARSHIP 2011

     APPLICATION FORM

    Please complete this application and mail DEADLINE: the original with Curriculum Vitae to:

    CICOPS thJune 30, 2010 Università degli Studi di Pavia Corso Strada Nuova, 65

     27100 Pavia - ITALY

     Questions and enquiries: cicops@unipv.it

1. PERSONAL INFORMATION

Surname(s):

Name(s):

    Country of residence: Nationality:

    Date of Birth: Gender:

Postal address (preferred for communications):

    Postal address(other, if relevant):

    Telephone (office): Telephone (cell): Telephone (home):

    CICOPS CICOPS NIVERSITÀ DEGLI TUDI DI AVIA SP NIVERSITÀ DEGLI STUDI DI PAVIA UUCentre for International Cooperation & Development Corso Strada Nuova, 65 Tel +39 0382.984241/4232 27100 Pavia ITALY Fax +39 0382.984092 P.Iva 00462870189 ? C.F. 80007270186 cicops@unipv.it

    Fax: Email address:

Italian fiscal code:

    (if already in posession)

Mother tongue: Other languages:

2. EMPLOYMENT

Current employer / institution:

Current position / title:

     No. of years teaching experience:

    No. of years experience working in International organizations / institutions:

3. RESEARCH ACTIVITIES

Main areas of research:

Current research activities:

Past research activities:

Relevant publications:

    CICOPS CICOPS NIVERSITÀ DEGLI TUDI DI AVIA SP NIVERSITÀ DEGLI STUDI DI PAVIA UUCentre for International Cooperation & Development Corso Strada Nuova, 65 Tel +39 0382.984241/4232 27100 Pavia ITALY Fax +39 0382.984092 P.Iva 00462870189 ? C.F. 80007270186 cicops@unipv.it

4. PROPOSED COLLABORATION AT UNIVERSITY OF PAVIA

    **Please note that it is mandatory to have a reference letter from**

    your collaborator at the University of Pavia.

    Contact person / collaborator at University of Pavia:

No. of years of collaboration:

    (if relevant)

    Department or Faculty in which research will be carried out:

    Proposed area of joint research or title of research project:

5. PERIOD OF STAY IN PAVIA

Proposed number of weeks (4-10):

     Proposed dates:

    (be as precise as possible)

Special requests:

6. OTHER INFORMATION OR COMMENTS

Signature of Applicant: Date & Place:

_________________________ ________________________

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