Registration form for research internship

"*" indicates required fields

1Personal info

2Contents of the internship

3Budget

4Complete

5Send

Applications for internships abroad can be submitted by Faculty of Medical Sciences/UMCG students only.

Name*

First name Surname

E-mail address*

Enter e-mail address Confirm email address

Address*

Postcode*

Place of residence*

S-number*

Specification*

Academic year*

Upload a short and signed proposal*

Drop files here or

Max. file size: 64 MB, Max. files: 1.

Location*

Scheduled timeframe*

Supervision*

Background*

Objectives*

Techniques*

Literature references (maximum 5)*

Budget

A sound budget for the internship that itemizes all costs and income, including the present De Cock-Hadders Foundation fund application

Cost type*

Amount*

Applied for from De Cock-Hadders Foundation*

Applied for or recently obtained from elsewhere*

Cost type

Amount

Gevraagd aan De Cock-Hadders

Applied for or recently obtained from elsewhere

Kostensoort

Bedrag

Applied for from De Cock-Hadders Foundation

Applied for or recently obtained from elsewhere

Kostensoort

Bedrag

Applied for from De Cock-Hadders Foundation

Applied for or recently obtained from elsewhere

Kostensoort

Bedrag

Applied for from De Cock-Hadders Foundation

Name of applicant*

Date*

MM slash DD slash YYYY

Signature of applicant*

Drop files here or

Max. file size: 64 MB, Max. files: 1.

Name of supervisor*

Date*

MM slash DD slash YYYY

Signature of applicant*

Drop files here or

Max. file size: 64 MB, Max. files: 1.

* As an alternative to a digital signature from your supervisor, please include a copy of the letter signed by your supervisor, in which they state that they have read your application and have approved the content. This copy can be uploaded to the above box.

Terms and conditions*

I have completed this form truthfully and I agree to the terms and conditions.

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Name

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