APPLICATION FORM FOR A STUDY STAY AT THE N.I.A.
Personal Data
a. First & Last Name:
b. Usual Name:
c. Sex:
d. Place of birth:
e. Date of birth:
f. Mailing address:
g. Telephone Number Home:
h. Telephone Number Work:
i.
Emergency address:
j. Mobile phone:
k. E-mail:
Stay
From
until
Studies/training
a. Educational Institution:
b. Subject/field of study:
You are:
a. Student
b. PhD Student
c. Researcher - Professor
d. Staff
e. Other
Reseach/project:
Person(s) supervising the project in the Netherlands:
If relevant, person(s) supervising the project in Greece: