Name	Click or tap here to enter text.
Address and current country of residence	Click or tap here to enter text.
E-mail address	Click or tap here to enter text.
University	Click or tap here to enter text.
Title of the paper/dissertation to be presented at the Summer School	Click or tap here to enter text.

1. Are you funded during your PhD, either through a monthly stipend, employment or similar?	☐Yes ☐No ☐ Only partially funded
2. If yes, what is the time frame of your funding? Provide a start-date and end-date of your funding or provide further comments if necessary.	Start date Click or tap here to enter text. End date Click or tap here to enter text. Comments
3. How high is your monthly fund? Please check the appropriate box.	☐ Below 500€ ☐ Below 1.000€ ☐ Below 1.500€ ☐ Above 1.500€
4. Do you have a yearly travel allowance from your home university? If yes, please specify.	☐Yes ☐No Amount Click or tap here to enter text.
Can you apply for funding at your home university to attend the Summer School?	☐Yes ☐No
5. Can you apply for funding from other sources, for example from a national funding institution, to attend the Summer School?	☐Yes ☐No

6. How long have you been enrolled as a PhD student?	Click or tap here to enter text.
7. Do you have access to regular feedback sessions on your PhD at your home university, for example in a regular PhD seminar or colloquium?	☐Yes ☐No
8. Have you ever attended a national conference or PhD workshop?	☐Yes ☐No
9. Have you ever attended an international conference or PhD workshop during your PhD education?	☐Yes ☐No
10. Have you ever attended an ECREA ECC conference?	☐Yes ☐No

11. Are you a member of ECREA?	☐Individual member ☐Member through institution ☐ I am not an ECREA member*
12. Are you a member of YECREA?	☐Yes ☐No
13. Are you active/have been active in the past as YECREA representative in any of ECREA Sections or Temporary Working Groups?	☐Yes ☐No
14. Are you a member of any other research association? If yes, please specify which.	☐Yes ☐No Click or tap here to enter text.

* Only ECREA members are eligible to receive Summer School grants. Candidates can apply for grants even if they are not ECREA members, but must become ECREA members by 1 May 2019 if they are selected to receive the grant. Not being an ECREA member will not affect the evaluation for the grant.

15. Please provide a brief statement of purpose (max. 500 words), specifying your

personal situation and reasons for applying to for the Summer School grant.

I certify that the information provided on this application is accurate. I understand that

withholding of information or giving false information will result in a refusal to be eligible for

funding.

The information provided in this form will be treated confidentially and in accordance with Belgian legislation and EU privacy protection regulation. The application forms will be stored by ECREA until 1 January 2020, after which date they will be deleted.

Signature Date and place Click or tap here to enter text.