Your browser does not support javascript. This is required for using the requested form.
Personal details
Last name:
Initials:
First name:
Title(s):
Gender:
Male
Female
Date of birth:
dd/mm/yyyy
Place and country of birth:
Contact information
(please mention your present position)
Faculty and Research Institute:
[Select One]
FF - GRIPh
FF - Other institutes
FGMW - HI
FGMW - Other institutes
FL - CLCG
FL - Other institutes
FMW/UMCG - BCN-BRAIN
FWN - CBN
FWN - JBI
FWN - ALICE
FWN - Other institutes
UT - MIRA
UT - Other institutes
None of the above...
Department:
'Internal zip code' (HPC):
Appointed since:
dd/mm/yyyy
Appointed as:
Please, select one
Full professor
Adjunct professor
Associate professor
Assistant professor
Postdoc Researcher
Other tenured staff
Field/Discipline:
P-number:
Expertise/Keywords:
Personal webpage:
Email address:
*
Telephone number:
Home address
Street and number:
Zip code and city:
Telephone number:
Personal Email address:
Level of education/university degree
(please mention the studies you graduated in)
University/Universities:
Degree:
BSc
MSc
PhD
Other:
Other:
Remarks
Remarks:
*
=
Input is required