Application Form for Short-term Visit to DKFZ

* Denotes a required field

Proposing member of Alumni DKFZ

Last name*:

First name*:

Title:

Function*:

Full address of research institution*:

E-mail address*:

Brief statement of support (no more than 5 sentences)*:

Applicant

Last name*:

First name*:

Current academic status*:

Citizenship*:

Place of birth*:

Date of birth*:

Full address of home institution*:

E-mail address:

DKFZ scientists and laboratories to be visited

Nr. 1*:

Nr. 2:

Brief statement of DKFZ scientist(s) to be visited, including plans for
possible funding of the extended research stay and e-mail address*:

Planned time of short-term visit:

Planned time of extended research stay in Heidelberg:

Current research supervisor

Last name*:

First name*:

Title*:

Function*:

Full address of research institution*:

E-mail address*:

General field of research (with two publication references)*:

To be attached:

If possible use PDF-files up to a size of 5 MB.

1. Curriculum vitae, which includes grade of final examination, title
and grade of dissertation (no more than one page), and portrait photograph*:

2. List of publications (only peer-reviewed papers, no abstracts):

The initial round of applications must be submitted until February 15, 2012, to the following address:

Prof. Dr. D. Keppler
Chairman Alumni DKFZ
Im Neuenheimer Fled 280
German Cancer Research Center (DKFZ)
69120 Heidelberg, Germany
E-mail: d.keppler@dkfz.de

Applications may be submitted by e-mail.

Navigation des Hauptbereiches

Application Form for Short-term Visit to DKFZ

Proposing member of Alumni DKFZ

Applicant

Current research supervisor

To be attached: