SIGN IN   |   JOIN IRG   |   RENEW MEMBERSHIP

Ron Cockcroft Award (RCA) Application Form

Read the Conditions for the RCA and the following instructions before you fill out this form.

The application form should be completed in English. Type directly in the fields below. Answer all questions concisely even if the answer is provided in a separate attachment. If you have any questions, please contact IRG-WP.

If you would prefer to submit your application by mail, download our application form.


Personal Information

MALE     FEMALE
Family Name
First Name
Position
Citizenship
Year of Birth
Address of current place of work or study including name of organisation, university, firm etc
Organisation
Email
Fax
Telephone

Background Information

Education: Specify degrees, diplomas etc. Forward copies of relevant documents to the Secretariat.
Degree 1:
Date:
Institution:
Degree 2:
Date:
Institution:
Degree 3:
Date:
Institution:
Professional experience relevant to this application:
Publications:
Intended conference presentation:
What do you think is the scientific impact of your research?

Estimate of Necessary Expenditure

Planned Budget (in US Dollars or Euros)
Travel   $
Accommodation   $
Food
(meal plan)
  $
Miscellaneous   $
  Total Expenses:   $
Proposed Funding
Amount requested from RCA
Funds from the Institute or other sources
Personal contribution
Total funding support

Sponsors

Names of two present IRG members who have been asked to sponsor the application by sending letters of reference directly to the IRG Secretariat. They must be in a position to judge your qualifications for the RCA. Note: One of them must come from an institute other than your own.

1. 
2. 

It is your responsibility to ensure sponsors' letters on your behalf arrive at the Secretariat before 15 December.

I hereby certify that I have read and accepted the conditions and that the statements given in this application are true.

Signature* (type your name)

Date* (year/month/date)

* Required


For questions about this Application Form, contact:
IRG Secretariat
Box 5609, SE-114 86 Stockholm, SWEDEN
Telefax: Int + 46 8 10 80 81
Email: irg@sp.se