Tel.: 39 40 2240552 Fax: 39 40 22407552 ictp.kfas@ictp.

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REQUEST FOR A GRANT UNDER THE AGREEMENT BETWEEN THE KUWAIT FOUNDATION FOR THE ADVANCEMENT OF SCIENCES AND THE ABDUS SALAM INTERNATIONAL CENTRE FOR THEORETICAL PHYSICS

INSTRUCTIONS Two copies of this form must be completed by those scientists from Arab and Islamic countries applying to visit the ICTP supported by a grant from the Kuwait Foundation for the Advancement of Sciences (KFAS). One completed form should be sent by email to the Abdus Salam International Centre for Theoretical Physics at ictp.kfas@ictp.it and the other should be forwarded to the Director General of the Kuwait Foundation for the Advancement of Sciences, Kuwait, at oip@kfas.org.kw.

Please note that: - A recent photograph of the candidate must be attached. - Each question must be answered clearly and completely. - If more space is required (for the list of publications, for example), additional pages may be attached.

Request for a Grant under the Kuwait Foundation for the Advancement of Sciences
Family Name: Maiden Name: (For women) Date of Birth: Present Nationality: Nationality at Birth: Place of Birth (City & Country): Marital Status: Number of Children: Telephone: Other Names: Sex: M / F Please attach a recent photo

Full Name and Address of Permanent Institute: Name & Address:

Fax:

City: Post Code: Country: Full Name and Address of Present Institute: (IF DIFFERENT FROM PERMANENT INSTITUTE!) Name & Address:

E-Mail:

Telephone:

Fax:

City: Post Code: Country: Address Valid Until: Home Address: Telephone: Fax: City: Post Code: Country: Mailing Address: Permanent: Present: Home: ICTP activity relevant to your work which you are interested in joining (indicate SMR no): E-Mail: E-Mail:

Expected arrival date:

Expected departure date:

EDUCATION (Higher Degrees - start with last Institute attended) Name of Institute Dates Attended Qualification Obtained

Participation in Seminars, Summer schools, Conferences etc. Name & Place Year

Have you participated in past ICTP activities? YES / NO If Yes, which?

SCIENTIFIC EMPLOYMENT AND ACADEMIC RESPONSIBILITY Name of Institute Period of Service Duties

Describe your present employment and duties, stating also any position you hold in the scientific administration of your institute.

Give a brief account of your work, its highlights and your present research problems.

Please give details of any scientific society or professional organization of which you are or have been a member. Name of Organization Your Function

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Request for a Grant under the Kuwait Foundation for the Advancement of Sciences FIELD OF INTEREST
PLEASE UNDERLINE YOUR PRIMARY FIELD OF INTEREST ONLY AND INDICATE UP TO FOUR OTHER FIELDS WITH A CROSS (X). 10.PHYSICS OF CONDENSED MATTER 11. Solid State Physics 12. Atomic, Molecular 13. Materials Science 14. Surfaces and Interfaces 15. Statistical Physics 16. Computational Physics in Condensed Matter 20.PHYSICS OF HIGH AND INTERMEDIATE ENERGIES 21. High Energy and Particle Physics 22. Relativity, Cosmology and Astrophysics 23. Plasma Physics 24. Nuclear Physics 30.MATHEMATICS 31. Applicable Mathematics including: Mathematical Ecology, Systems Analysis, Mathematics of Developments, Mathematics in Industry 33. Algebra 34. Geometry 35. Topology 36. Differential Equations 37. Analysis 38. Mathematical Physics 40.PHYSICS AND ENERGY 43. Non-Conventional Energy (Solar, Wind and others) 50.PHYSICS OF THE ENVIRONMENT 51. Geophysics 52. Soil Physics 53. Climatology and Meteorology 80.MISCELLANEOUS 82. Digital Communications and Computer Networking 90.PHYSICS OF THE 91. Neurophysics 92. Biophysics 93. Medical Physics

LIVING STATE

AO.APPLIED PHYSICS A2. Microelectronics A5. Synchrotron Radiation A7. Lasers SPECIFY YOUR MAIN RESEARCH TOPICS USING A MAXIMUM OF 150 CHARACTERS:

P u b l i c a t i o n s
Title 1 Author/s Reference Title 2 Author/s Reference Title 3 Author/s Reference Title 4 Author/s Reference Title 5 Author/s Reference List foreign research institutes visited. Host Institute Duration of visit

Purpose of visit

LANGUAGES What is your mother tongue? Indicate your proficiency in English: Reading Writing Fair Good

Speaking

Excellent Name & Address of person to contact in case of emergency - Relationship:

Telephone: Telefax: E-Mail: I certify that the statements made by me above are true and complete. If selected, I undertake to refrain from engaging in any political or other activities which would reflect unfavourably on the international status of the Abdus Salam International Centre for Theoretical Physics. I understand that any breach of this undertaking may result in the termination of the arrangements relating to my visits to the Centre. I agree that my email address and WWW.ICTP.IT page if I am accepted. Yes photograph may be made public on the

No

______________________ Signature of candidate

___________________ Place

_________________ Date

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