ICOPA 2018

19-24 August 2018

EXCO, DAEGU, KOREA

Application form for ICOPA 2018 Travel Grant

Part 1: Personal information

Please check (V) the relevant qualification you are
( ) are in full-time training as undergraduate, graduate, or medical students at institutions of higher
learning in a scientific field related to parasitology who have not earned a doctorate level degree

( ) are students who are in the late stages of PhD training

or postdoctoral fellows within 5 years of obtaining his/her PhD Degree
or assistant professors who were appointed within 3 years
Last name: First name:

Gender: Date of birth (dd.mm.yy):

□ Male □ Female

Present Country of Residence Nationality

Present Affiliation (Institution):

Department:

Address:

City: State: Zip / Postal code

Country:

Phone: Fax: E-mail:

Category of Applicant:

□ PhD training □ Postdoctoral training (within 5 years) □ Assistant professor (within 3 years)
Declaration: I have not received any grants from previous ICOPA meetings:

□ No, I have not received □ Yes, I have received

1
ICOPA 2018
19-24 August 2018
EXCO, DAEGU, KOREA

Part 2: Education, Career Experience and Awards Received

List degrees awarded (for each degree: indicate institution, country and year degree completed)
[If presently enrolled for PhD studies, indicate institution, country and year PhD training commenced]
List present and past fellowships held and professional positions held, relevant to this application
List professional and scientific awards received
[Expand this box as required]

Part 3: Publications
ex) 1. Authors, Title, Journal volume, page numbers (Year)
**For each publication listed below, Include as attachments to this Application copies of the title pages of
all manuscripts in your list. The title page should include the full title, all authors' full names, and their
institutions.
[Expand this box as required]