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Applicationform PhD-training

Family name:
First name:Title:
Date of birth:Male: Female:
InstituteDepartment
Working address:Room:
Zipcode:Place:
Business phone:Fax:
E-mail address
Address privéHome phone:
Zipcode:Place:
You are:
= AIO;  = OIO;  = AGIO/AGNIO = Other:
Title research project:
Promotor:
Supervisor:
Date of appointment: (yyyy-mm-dd)
Appointment ends on: (yyyy-mm-dd)
Financing: = Fac VET - PHAR - NED (AZU-WKZ)
= NWO
= Collecting box fund
= Industry - EU ministry - Econ.Aff or WVS - contract research
= Others:
Vakken waarin tentamen is afgelegd op pre-doctoraal niveau:= Fysiologie, = celbiologie, = moleculaire biologie, = biochemie, = pathologie, = immunologie, = microbiologie, = biostatistiek
Specialization:
Microsectie number: