Umicore Materials Technology PhD Award 2017 –p.1of3

Umicore Materials Technology
2017 PhD Award / /
Fonds de la Recherche Scientifique-FNRS
Rue d’Egmont 5 – 1000 BRUXELLES
Tel. 02 504 92 40
E-mail: Website: / received date
number / file
Form to return to the Fonds de la Recherche Scientifique-FNRS via the address by Monday July 3rd 2017 at the latest.

Details of the candidate

1 /

Enter your personal details.

first and surname
legal domicile address
private phone
department address
work phone
e-mail
birthplace
date of birth / day / month / year
nationality / gender / m / v
civil status
2 / Enter the details of your university degrees.
Please state full and exact designation.
name of the degree / English name of the degree / Institution/
organisation / date (ddmmyyyy)
3 / Enter your present occupation along with the coordinates of the according institution/organisation.
4 / Enter the name and address of the current research unit to which you belong and the first and surname of the head of this research unit.
Name:
Address:
Head of unit:

Details of your PhD research

Field of science and title
5 / Describe the particular field of science of this research program in three keywords.
6 / Select to which of the following fields your contribution belong.
Recycling / resources scarcity (related to materials)
Materials for catalysis
Materials for batteries
7 / Give the English title of the research presented for the prize.
Use up to 240 characters, signs or spaces.
8 / Enter the first and surname of the primary supervisor of the PhD thesis, the address of the institution and the first and surname of de head of the research unit.
primary supervisor
address of the institution
head of the research unit
Details of scientific publications
9 / Give an overview of your scientific publications and indicate those related to the prize.
For each publication, mention the following data:
the title, completely without abbreviations
the journal. Use only the international accepted abbreviations.
the date of publication
the number of pages, and for publications part of a book or magazine, the reference ‘from page x to page y’
the names of the authors, according to the presentation order
the impact factor of the journal
the number of citations for each paper.
The F.R.S.-FNRS reserves the right to call for offprints.
National and international awards
10 / List all your national and international awards.
Important! Please mention below all awards that you have received for your research.
Indicate for each award the following: the name of the award, the date received, the amount, the theme of the award and the origin, i.e. the organization which provided the award.
name of the prize / date / amount / theme / origin
euro
euro
euro
euro
euro

Mandatory attachments

11 / Enclose the following documents with this form and tick them in the tick list.

a detailed curriculum vitae

an electronic version of your PhD thesis

a summary in layman’s terms of max. ½ page

an executive scientific summary of max. 5 pages emphasizing the originality of the research

Signature of the applicant

12 / Complete the following statement.

I confirm that I am in a position to freely interact with Umicore and that I am not an employee of Umicore or its branches, nor have a I been an employee of Umicore or its branches before; the PhD research submitted here was not carried out in collaboration with Umicore.

I declare that all information in this form is filled in truthfully.
date / day / month / year
handwrittensignature
first name and last name