Application Form for Travel Grant
The Ninth World Congress of ICCEES in Makuhari, Japan
August 3-8, 2015
The following information is necessary for us to conduct our review. Please make your responses as detailed and accurate as possible. Fill in each of the blanks, in type or print. Do not simply send us your CV.
1.Full Name:
______
(Surname) (First or given name) (Middle name)
2. Your World CongressID number: ______
3.Present address
Home:______
______
Tel.: Fax.:E-mail:
Office:______
______
Tel.: Fax.:E-mail:
4. Date of birth: ______
5.Citizenship: ______
6.Present affiliation and position
Affiliation:
Position:
7.Your monthly income (in the currencyof your country of residence): ______You must submit a scanned image of the document(s) proving this income.
8. Airfare amount from departing airport to Narita/Haneda International Airport: ______You must submit a scanned image of the airfare bill.
9. Highest academic degree you have acquired(In the case of Russian degrees, please specify by Russian names such as kandidat or doktornauk):
______
(Type of degree) (Name of degree-granting institution) (Year)
10. Discipline and field of specialization:
(a)Academic discipline (history, political science, geography etc.):
(b)Field of specialization (e.g. 19th-century Russian history, political participation in Poland, economic geography of the CIS, etc.):
11. Presentation Paper Abstract (if you are a paper presenter, please copy and paste the text you submitted to the Organizing Committee; if you are a roundtable panelist, please leave this column unfilled):
12.______Education and academic training (Please specify in chronological order, giving all essential dates, beginning with graduation from university and ending with the highest degree):
13.Professional career (Please specify in chronological order, beginning with the present, giving all essential dates):
14.Publications / Writings (List of books, articles, and all other writings that you consider as your most important contributions to scholarship with complete publication data. Please limit to 10 items.It is not necessary to translate the titles of your publications into English. Please just list your publications in the languages which they were originally published):
I hereby declare that the above is true and correct to the best of my knowledge.
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(Place) (Date) (Signature)