POLISH ACADEMY OF SCIENCES APPLICATION FOR A RESEARCH VISIT

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THE POLISH ACADEMY OF SCIENCES

Polish Academy of Sciences

APPLICATION FOR A RESEARCH VISIT AT

Institute to be visited: …………………………………..

PART I: VISITOR PERSONAL DATA

1. First name, Family name, Academic degree/Title:

2. Affiliation (Institution, Country):

3. E-mail and telephone number:

4. Field of specialization:

5. Statement on scientific career (posts held, research activities, prizes, awards, etc):

6. Main recent publications (max. 6):

PART II: HOST PERSONAL DATA

1. First name, Family name, Academic degree/Title:

2. E-mail and telephone number:

3. Field of specialization:

4. Statement on scientific career (posts held, research activities, prizes, awards, etc):

5. Main recent publications (max. 6):

PART III: VISIT DETAILS

7. Dates and duration of the visit:

Dates :

Duration (in days) :

8. Detailed time schedule of the visit:

9. Planned cost of the visit:

Cost item :	Cost :
Tickets
Per diem (max. 90 PLN x day) if applicable
Accommodation
Total

10. State the purpose of the visit. In particular will you: (a) give lectures or seminars (if so, please give their title/s); (b) work on a joint paper or joint proposal (if so, please give the title of the planned publication or the title of the project inculding planned sources of funding); (c) use a special facility of the partner institution; (d) other

11. Describe planned results of the visit:

By submitting the Application for a research visit at … you accept the general terms of the contract
(the so-called “Ogólne Warunki Umowy” regarding the realization of study visits which can be found
at our website at:

https://instytucja.pan.pl/index.php?option=com_content&view=article&layout=edit&id=4854

...................................... .................................................

(date) (Signature of the Host)

...................................... .................................................

(date) (Signature of the Visitor)

...................................... .................................................

(date) (Signature of the Director of the Host Institution)

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