To be sent to: Ulysse Serres, SISSA, Via Beirut 2-4, 34014 Trieste, Italy ------------------------------------------------------------------------------ THE ABDUS SALAM INTERNATIONAL CENTRE FOR THEORETICAL PHYSICS AND INTERNATIONAL SCHOOL FOR ADVANCED STUDIES REQUEST FOR PARTICIPATION Trimester 2003 on: "Dynamical and Control Systems" Sept. 8 - Dec. 7, 2003. e-mail : dcs03-application@sissa.it _______________________________________________________________________________ INSTRUCTIONS Each question must be answered clearly and completely. Type or print in ink. If more space is required, attach additional pages. ================ IMPORTANT NOTE: GRADUATE AND DOCTORAL STUDENTS -->MUST<-- INCLUDE TWO LETTERS OF RECOMMENDATION. _______________________________________________________________________________ IMPORTANT: Application forms sent via e-mail will be accepted ONLY when the deadline is imminent. The file should be sent as attachment, in RTF format. In any case, a signed hard copy must follow by post. _______________________________________________________________________________ A recent photograph of the candidate should be attached here,signed legibly on the reverse. _______________________________________________________________________________ NOTE: This request will be processed ONLY if the permanent address (and present address, if different) is clearly indicated. The ICTP cannot process any visa request, unless ALL requested personal data are provided. _______________________________________________________________________________ PERSONAL DATA _______________________________________________________________________________ SURNAME/FAMILY Name: MAIDEN Name: First Name: Middle Name(s): Sex: _______________________________________________________________________________ IMPORTANT: PLEASE ALSO COMPLETE THIS SECTION, IF YOUR NAMES IN YOUR PASSPORT ARE SPELT DIFFERENTLY FROM THE ABOVE. SURNAME/FAMILY Name: MAIDEN Name: First Name: Middle Name(s): _______________________________________________________________________________ Place of birth (City and Country): Present nationality: Date of birth (Year - Month - Day): _______________________________________________________________________________ Full address of permanent Institution: Institute: Tel. No.: Telex/Cable: Telefax: Your Office: Tel. No.: Telefax: e-mail *: _______________________________________________________________________________ Full address of present Institution (if different from permanent): Institute: Tel. No.: Telex/Cable: Telefax: Your Office: Tel. No.: Telefax: e-mail *: until: Date .......................... _______________________________________________________________________________ (*) My e-mail address(es) may be made public on the ICTP WWW pages: YES /__/ NO /__/ _______________________________________________________________________________ Home address: Tel. No: _______________________________________________________________________________ Mailing address - please indicate whether: Permanent /__/ Present /__/ Home /__/ _____________________________________________________________________________ Name and address of person to notify in case of emergency - Relationship: Tel. No.: ______________________________________________________________________________ EDUCATION (higher degrees) University or equivalent Years attended Degrees Name and place From to ______________________________________________________________________________ Seminars, summer schools, conferences or research Name and place Year _______________________________________________________________________________ SCIENTIFIC EMPLOYMENT AND ACADEMIC RESPONSIBILITY Research Institution or University Period of duty Academic Name and place From to responsibilities Present employment and duties, and foreseen employment upon return to home country after the activity: _______________________________________________________________________________ Have you participated in past ICTP activities? If yes, which? YES /__/ NO /__/ Are you applying to any other ICTP activities taking place in 2003? If yes, which? YES /__/ NO /__/ Mention briefly your previous research experience, and explain your reasons for wishing to participate in this activity: NB: Our Scientific Information System keeps track of ALL applications made by the candidate to earlier ICTP activities. As a consequence, when the subject of the present activity is far from your previous applications, an explanation (not more than 200 words) of your change of interest should be included. _______________________________________________________________________________ PRESENT FIELD OF INTEREST (please indicate on the list below your TWO primary fields of interest, in order of priority, 1 and 2). 10. PHYSICS OF CONDENSED MATTER 11. Solid State Physics 12. Atomic and Molecular Physics 13. Materials Science 14. Surfaces and Interfaces 15. Statistical Physics 16. Computational Physics in Condensed Matter 20. PHYSICS OF HIGH AND INTERMEDIATE ENERGIES 21. High Energy and Particle Physics 22. Relativity, Cosmology & Astrophysics 23. Plasma Physics 24. Nuclear Physics 30. MATHEMATICS 31. Applicable Mathematics including: - Mathematical Ecology, - Systems Analysis, - Mathematical Economy - Mathematics in Industry 33. Algebra 34. Geometry 35. Topology 36. Differential Equations 37. Analysis 38. Mathematical Physics 40. PHYSICS AND ENERGY B1. SPACE PHYSICS 41. Physics of Nuclear Reactors 42. Physics of Controlled Fusion 43. Non-Conventional Energy (Solar, Wind and others) 44. Nuclear Energy related technologies 50. PHYSICS AND ENVIRONMENT 51. Solid Earth Geophysics 52. Soil Physics 53. Climatology and Meteorology 54. Physics of the Oceans 55. Physics of Desertification 56. Physics of the Atmosphere, Troposphere Magnetosphere, Aeronomy 57. Environmental Monitoring and Remote Sensing 60. PHYSICS TEACHING 61. English 62. French 63. Spanish 64. Arab 80. MISCELLANEOUS 81. Others 82. Digital Communications & Computer Networking 90. PHYSICS OF THE LIVING STATE 91. Neurophysics 92. Biophysics 93. Medical Physics AO. APPLIED PHYSICS A1. Physics in Industry A2. Microelectronics A3. Fibre Optics for Communications A4. Instrumentation A5. Synchrotron Radiation A6. Non-destructive Evaluation A7. Lasers AA. Applied Superconductivity _______________________________________________________________________________ Kindly supply a keyword description of your current scientific activities, as follows (strictly within indicated lengths) : 1) Area of research: (e.g. PROBABILITY THEORY) /________________________/ (no more than 15 characters) 2) Specific topic of interest: (e.g. RANDOM ENVIRONMENT) /______________________________________________/ (no more than 30 characters) ____________________________________________________________________________ List your scientific publications including books and articles (authors, title, Journal) in the period 1997-2002: _______________________________________________________________________________ Kindly state any positions you hold in the scientific administration of your Institution or any of the national scientific Institutions. _______________________________________________________________________________ Indicate below your proficiency in the English language Reading: Good /__/ Average /__/ Poor /__/ Writing: Good /__/ Average /__/ Poor /__/ Speaking: Good /__/ Average /__/ Poor /__/ _______________________________________________________________________________ I certify that the statements made by me above are true and complete. If accepted, I undertake to refrain from engaging in any political or other activities which would reflect unfavourably on the international status of the ICTP. I understand that any breach of this undertaking may result in the termination of the arrangements relating to my visit at the Centre. _________________________ _______________________ Signature of applicant Date =============================end of application==========================