application form autumn school 2023

PERSONAL DETAILS

Gender

Male

Female

Divers

First Name

Middle Name

Last Name

E-Mail-Adresse

Nationality

Address

Date of Birth

Place of Birth

Country of Birth

Current Status

I am a doctoral candidate

I am a postdoc

I am a Center for Mind, Brain and Behaviour (CMBB) Master Student

if you selected CMBB Master enter your specialisation

How did you learn about the Autumn School Series?

Diet information

No dietary requirements

Vegetarian

Vegan

Other

In case you selected "other":Please enter your dietary information:

YOUR EDUCATION

Your most recent university degree:

Which is your most recent Degree:

In case you entered "other": What is your recent university degree?

Please enter the subject of your most recent degree (e.g. biology, medicine, ...)

Please enter the university of your most recent degree (e.g. JLU Gießen,...)

Please enter the country of your university (recent degree)

Please enter your score (recent degree)

Please upload your recent degree certificate:

Please upload your recent transcript of records:

Please upload your CV

SCIENTIFIC BACKGROUND

Select your fields of research

Neuroscience

Immunology

Stress Research

Psychiatry/Psychosomatics/Psychology

In case you selected "other":Please enter your field of research:

Exact Topic

Statement of Motivation

REFERENCES - Please use our template!

Referee 1

Titel

Name

Institution

E-Mail

Upload first letter of reference

Please use the template given in the informations for applicants!

Referee 2

Titel

Name

Institution

E-Mail

Upload second letter of reference

Please use the template given in the informations for applicants!

DATA PROTECTION

information regarding covid 19

I agree

Regulations concerning Covid 19 will be applied as required at the time of the event

Data storage and processing

I agree

By completing and submitting this form, I agree that my personal data will be electronically stored and processed by the organisers of the PNI Autumn School Series for the purpose of application and management of my attendance only. I agree the data can be transferred to third parties at the JLU Giessen and the UMR Marburg aswell as service providers during the autumn school (e.g. hotel etc.). I can revoke the release at any time by writing a message to office@ggl.uni-giessen.de.

letter of reference

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application form autumn school 2023