SCIENTIFIC COOPERATION BETWEEN NRF

(NATIONAL RESEARCH FOUNDATION, SOUTH AFRICA) AND

F.R.S.-FNRS (THE WALLONIA-BRUSSELS FEDERATION OF BELGIUM)

______

APPLICATION FOR A STAY IN

SOUTH AFRICA

Form to be completed by June 30th, 2016

Each application registered by the "Fonds de la Recherche Scientifique - FNRS" is followed by an acknowledgement of receipt.

Contact F.R.S.-FNRS :Contact NRF :

Tél. : 02 504 93 05Tél. : +27 (0)12 481 4385

Fax : 02 504 92 92Fax : +27 (0)12 481 4044

E-mail : -mail :

SCIENTIFIC COOPERATION BETWEEN NRF (SOUTH AFRICA) AND

F.R.S.-FNRS (THE WALLONIA-BRUSSELS FEDERATION OF BELGIUM)

______

APPLICATION FOR A STAY IN SOUTH AFRICA (NRF)

1.ADMINISTRATIVE DETAIL

Project title
Duration of the project:2017 - 2018
Specific scientific field of research
1.1 The Wallonia-Brussels Federation of Belgium

Belgian coordinator of the project(Belgium)

Last name
First name(s)
Gender
/ Female  / Male  /
Date of birth
/ (DD/MM/YYYY) /
Nationality
Address at the university
University and department or laboratory
Street name and number / City and postal code
Phone / Fax
E-mail
Web site
Position/diplomas
Current position
University degree / Date of award
(DD/MM/YYYY)
List of the Belgian researchers participating to the project
Last name and first name(s)
University and current position
University degree
/ Date of award
(DD/MM/YYYY)
Last name and first name(s)
University and current position
University degree
/ Date of award
(DD/MM/YYYY)
Last name and first name(s)
University and current position
University degree
/ Date of award
(DD/MM/YYYY)
Last name and first name(s)
University and current position

University degree

/ Date of award

(DD/MM/YYYY)

Last name and first name(s)

University and current position

University degree

/ Date of award

(DD/MM/YYYY)

1.2.Partner country - South Africa

South African coordinator of the project (South Africa)

Last name
First name(s)

Gender

/ Female  / Male  /

Date of birth

/ (DD/MM/YYYY) /

Nationality

Address at the university
University and department or laboratory
Street name and number / City and postal code
Phone / Fax
E-mail
Web site
Position / diplomas
Current position
University degree / Date of award
(DD/MM/YYYY)
List of the South African researchers participating to the project

Last name and first name(s)

University and current position

University degree

/ Date of award

(DD/MM/YYYY)

Last name and first name(s)

University and current position

University degree

/ Date of award

(DD/MM/YYYY)

Last name and first name(s)

University and current position

University degree

/ Date of award

(DD/MM/YYYY)

Last name and first name(s)

University and current position

University degree

/ Date of award

(DD/MM/YYYY)

Last name and first name(s)

University and current position

University degree

/ Date of award

(DD/MM/YYYY)

1.3.Account number of the Belgian university to which the payment should be made
Account number
Name and address of the university
Name and address of the bank
Communication

2.DETAILED DESCRIPTION OF THE PROJECT (→max. 3 pages)

2.1. Scientific objectives of the project.
2.2. Methodology / Working plan.
2.3. Expected results of the project.
2.4. Added-value of the collaboration for Belgiumand South Africa.
2.5. Financial resources from other sources of funding.
  1. CV OF APPLICANTS AND LETTER OF AUTHORIZATION
Please send the following documents by e-mail:
3.1.curricula vitae of all researchers involved in the project (Belgians and South Africans);
3.2.letter of authorization of the South African coordinator.
  1. MISSIONS OF BELGIAN RESEARCHERS
4.1.Year 2017 (→ 1styear of the project)
From the Wallonia-Brussels Federation of Belgium to South Africa.
Number of missions
Last name and first name(s) of
Belgian researchers / Length of stay / From
(DD/MM) / To
(DD/MM)
-
-
-
-
-
-
4.2.Year 2018 (→ 2ndyear of the project)
From the Wallonia-Brussels Federation of Belgium to South Africa.
Number of missions
Last name and first name(s) of
Belgian researchers / Length of stay / From
(DD/MM) / To
(DD/MM)
-
-
-
-
-
-
  1. MISSIONS OF SOUTH AFRICAN RESEARCHERS
5.1.Year 2017(→ 1styear of the project)
From South Africa to the Wallonia-Brussels Federation of Belgium.
Number of missions
Last name and first name(s) of
South Africanresearchers / Length of stay / From
(DD/MM) / To
(DD/MM)
-
-
-
-
-
-
5.2.Year 2018 (→ 2ndyear of the project)
From South Africa to the Wallonia-Brussels Federation of Belgium.
Number of missions
Last name and first name(s) of
South Africanresearchers / Length of stay / From
(DD/MM) / To
(DD/MM)
-
-
-
-
-
-
Date:
Signature of the coordinator of the project for theWallonia-Brussels Federation of Belgium:

1