Institut Mittag-Leffler

Application for fellowship grant

Program:
Quantum Information Theory (fall 2010)
Algebraic Geometry with a view towards applications (spring 2011)

First name: Family name:
Date of birth: Male/Female: Nationality:
Family status (single, married, no. of children):
If you have family, will they accompany you during your stay:
Period for which the stay at Institut Mittag-Leffler is intended:
Present position:

Education:

Ph.D. obtained (when, where, title, name of advisor):

A short description of your research interests and plans:

Published papers and preprints, preferably provided with pointers to web sites:

(Papers that cannot be downloaded from a web site should be provided as PDF-files submitted via e-mail or else as paper copies.)

Letters of recommendation will be sent by:
1.
2.
3.

Outside sources of financial support during your stay at Institut Mittag-Leffler (if any):

Full address of correspondence, including e-mail address and fax number:

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