2022-2023 Initial Form for RG Organizers

PROPOSAL

Proposal Full Title *

Proposal Sub-Discipline *

Proposal Keywords *

Provide 3-5 keywords that are relevant to the proposal topic (do not include keywords that appear in the title).

REQUESTED PERIOD OF RESIDENCY

Residency duration *

Start date preference *

Start date flexibility? *

Yes

Alternative start date

ORGANIZER DETAILS

PERSONAL INFORMATION

First Name *

Last Name *

Sex *

Israeli ID (if applicable)

Address *

City *

Country *

ZIP code/postal code *

Email Address *

Cell phone *

ACADEMIC INFORMATION

Academic Position *

Primary University Affiliation *

University Department *

University Country *

Secondary University Affiliation

University Department

University Country

Research Discipline *

Research Sub-discipline *

Year of PhD Conferral *

Day

Month

Year

Add a second organizer? *

Yes

ORGANIZER #2 DETAILS