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FNR Award for Outstanding PhD thesis Application Form

FNR Award for Outstanding PhD thesis Application Form

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<strong>FNR</strong> <strong>Award</strong> <strong>for</strong> <strong>Outstanding</strong> <strong>PhD</strong> <strong>thesis</strong><br />

<strong>Application</strong> <strong>Form</strong><br />

1. Candidate’s and institution’s details<br />

Candidate postulating <strong>for</strong> the <strong>Award</strong><br />

Family name<br />

First Name<br />

Birth family name (if applicable)<br />

Title<br />

Function<br />

Date of Birth<br />

Gender<br />

Nationality<br />

Email address<br />

Postal address<br />

Institution’s details<br />

Name of main research institution 1<br />

Percentage of research time spent at main<br />

institution<br />

Name of person(s) in charge of supervision at<br />

main institution<br />

Name of <strong>PhD</strong> awarding institution (if different<br />

from above)<br />

Percentage of research time spent at <strong>PhD</strong><br />

awarding institution<br />

Name of person in charge of supervision at<br />

<strong>PhD</strong> awarding institution (if different from<br />

above)<br />

Name of other <strong>for</strong>mal collaborating institution<br />

Percentage of research time spent at<br />

institution<br />

Name of person in charge of supervision at<br />

institution<br />

1 institution where the major part of the <strong>PhD</strong> research work was conducted<br />

AWARD OUTSTANDING PHD - APPLICATION FORM 1 of 7 2/6/2012


Proposer (please fill in only if different from the candidate)<br />

Family name<br />

First Name<br />

Birth family name (if applicable)<br />

Title<br />

Function<br />

Date of Birth<br />

Gender<br />

Nationality<br />

Your connection with the candidate<br />

For Proposers only:<br />

Yes, I have in<strong>for</strong>med the candidate that I am submitting a proposal on his/her behalf <strong>for</strong> the<br />

<strong>Award</strong> <strong>for</strong> <strong>Outstanding</strong> <strong>PhD</strong> Thesis.<br />

AWARD OUTSTANDING PHD - APPLICATION FORM 2 of 7 2/6/2012


2. <strong>PhD</strong> research project<br />

Research domain (c.f. Frascati list)<br />

Main Domain<br />

Sub Domain<br />

Title of <strong>thesis</strong><br />

Keywords (max. 6)<br />

<strong>PhD</strong> <strong>thesis</strong><br />

Start of <strong>PhD</strong> (month/year)<br />

Date of <strong>thesis</strong> examination<br />

Members of <strong>thesis</strong> committee (name and<br />

institution)<br />

Date of official <strong>PhD</strong> award (<strong>PhD</strong> certificate)<br />

Final mark (if applicable)<br />

Please provide an abstract of your <strong>PhD</strong> research project (0,5 page)<br />

AWARD OUTSTANDING PHD - APPLICATION FORM 3 of 7 2/6/2012


Please list in full detail up to 3 of your most important 1 st or co- authored peerreviewed<br />

publications that have directly emerged from your <strong>PhD</strong> research work<br />

Title of the publication<br />

Main-Author(s)<br />

Co-author(s)<br />

Publication status published accepted <strong>for</strong> publication 2<br />

Name of the journal<br />

Name of the editor<br />

Is the journal listed in ISI Thompson Web of<br />

Science Yes No<br />

Is the journal listed in SCOPUS Yes No<br />

Year of publication<br />

Others (please specify)<br />

Title of the publication<br />

Main-Author(s)<br />

Co-author(s)<br />

Publication status published accepted <strong>for</strong> publication 2<br />

Name of the journal<br />

Name of the editor<br />

Is the journal listed in ISI Thompson Web of<br />

Science Yes No<br />

Is the journal listed in SCOPUS Yes No<br />

Year of publication<br />

Others (please specify)<br />

Title of the publication<br />

Main-Author(s)<br />

Co-author(s)<br />

Publication status published accepted <strong>for</strong> publication 2<br />

Name of the journal<br />

Name of the editor<br />

Is the journal listed in ISI Thompson Web of<br />

Science Yes No<br />

Is the journal listed in SCOPUS Yes No<br />

Year of publication<br />

Others (please specify)<br />

2 please provide letter from editor saying that paper is accepted<br />

AWARD OUTSTANDING PHD - APPLICATION FORM 4 of 7 2/6/2012


Please list and describe in detail any other outcomes that have directly emerged from<br />

your <strong>PhD</strong> research work, e.g. filed patent, monograph, book, conference, products,<br />

dissemination activities, collaborations, follow- up projects, etc. (0,5 page)<br />

Personal argumentation <strong>for</strong> your nomination <strong>for</strong> the <strong>Award</strong> of <strong>Outstanding</strong> <strong>PhD</strong> Thesis<br />

(1 page). Please address the selection criteria.<br />

AWARD OUTSTANDING PHD - APPLICATION FORM 5 of 7 2/6/2012


The following documents have to be joined to the completed application <strong>for</strong>m (see<br />

guidelines)<br />

• written summary of the <strong>PhD</strong> research work, the main findings and their specific<br />

contribution to the current state of knowledge (max. 10 p, incl. illustrations&references);<br />

the summary should be understandable to scientists who may not have expertise in the<br />

specialised subject field.<br />

• official certificate by the <strong>PhD</strong> awarding institution attesting the successful conclusion of<br />

the <strong>PhD</strong> or <strong>PhD</strong> diploma<br />

• electronic version (pdf) of the <strong>PhD</strong> <strong>thesis</strong> (may be sent separately on DVD)<br />

• updated CV of the applicant, including list of all publications by the applicant<br />

• any direct outcomes of the <strong>PhD</strong> research work, i.e. electronic version of peer-reviewed<br />

publications, book, monograph, conference, filed patent, etc.<br />

• any other element which illustrates the outstanding quality of the <strong>PhD</strong> <strong>thesis</strong> and/or the<br />

candidate (awards, etc.)<br />

• recommendation letter from a referee (i.e. the <strong>PhD</strong> supervisor or an alternative referee,<br />

who can give a qualified judgement on the quality of the <strong>PhD</strong> research work and/or the<br />

profile of the applicant, e.g. <strong>PhD</strong> scientific advisor, member of the <strong>thesis</strong> committee, etc.),<br />

describing why the <strong>thesis</strong> should be considered <strong>for</strong> the award. The recommendation letter<br />

should address the selection criteria. In the recommendation letter, the referee must<br />

identify him/herself and his/her connection with the applicant. 3<br />

3 In case the referee is the proposer of the application, no separate recommendation letter<br />

is required<br />

AWARD OUTSTANDING PHD - APPLICATION FORM 6 of 7 2/6/2012


3. Validation and signature<br />

Terms and Conditions<br />

The applicant declares that he/she has read the guidelines and that the given in<strong>for</strong>mation is correct<br />

and complete.<br />

The applicant declares to adhere to the rules of good research practice as outlined in The European<br />

Code of Conduct <strong>for</strong> Research Integrity (http://www.esf.org/activities/mo-<strong>for</strong>a/researchintegrity.html).<br />

He/she has to in<strong>for</strong>m the <strong>FNR</strong> in writing within 30 days about any modification concerning the given<br />

in<strong>for</strong>mation.<br />

In case of missing documents, the application is not eligible.<br />

The application has to be submitted until the relevant submission deadline in electronic <strong>for</strong>mat to the<br />

<strong>FNR</strong>.<br />

The undersigned authorises the National Research Fund to publish his/her name, e-mail address and<br />

his/her activity on the website of the National Research Fund (www.fnr.lu) as well as in the Fund’s<br />

activity report.<br />

I agree to the <strong>FNR</strong>’s terms and conditions<br />

* (mandatory field)<br />

Date<br />

Name and Signature<br />

Applicant<br />

AWARD OUTSTANDING PHD - APPLICATION FORM 7 of 7 2/6/2012

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