COSPAR Capacity Building Fellowship Application

Name:										Title:		
(Please CAPITALIZE family name)

Status: MSc student         PhD student        PostDoc        Faculty     

Institute:									
Address: 							
									
									
									
Email address:								
Telephone number:							
Data of birth						Gender:		

COSPAR Capacity-Building Workshop attended (Title/Location):
									
									

Brief description of proposed program of research:
											
											
											
											
											
	

										
											
										
											
											
Name, title and position of your collaborator:
											
											
Name of participating laboratory:
											
											
When do you wish your fellowship to start? 						
(Note that it will lapse if you do not take it up within 6 months of this date.) 

What was the topic of your project at the Capacity-Building workshop?
											
											
										
Who was your supervisor? 									

How have you used what you learned at the workshop since then?
											
			



								
											
											
											
											
If you have made a start on your program of research, what have you achieved thus far?
											
											
											
											
											
											
											
											
										
											
									
Are there any other factors you wish to bring to the attention of the selection panel?
											






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Date