Simons Workshop in Mathematics and Physics 2009: Application

Simons Workshop in Mathematics and Physics 2009

Stony Brook, July 27 - August 21, 2009.

Application Form

First Name:
(please do not enter any punctuations or accents in your name)

Last Name/Surname:
(please do not enter any punctuations or accents in your name)

Gender: M F

Institution:

Title/Position:

Address:

Email:

Phone:

FAX:

Year Ph.D. received/expected:

Name of Referee:
(Please arrange for one letter of recommendation to be
emailed to simonsworkinsti.physics.sunysb.edu)

Selected Publication 1 Title:

Publication 1 URL:

Selected Publication 2 Title:

Publication 2 URL:

Selected Publication 3 Title:

Publication 3 URL:

Brief Statement of Research Interest
(Please use line breaks)

URL of CV (if any):

URL of Research Statement (if any):

Proposed Date of Arrival: / / 2009

Proposed Date of Departure: / / 2009

Will you bring a laptop? Yes No

Do you expect to have a car? Yes No

Accommodation Required? Yes No

if yes, for how many persons?

Preferred Accomodation * On campus Bed & Breakfast Motel

* Campus dormitory housing will be available for the first two weeks of the workshop. It is convenient though not luxurious. Off-campus housing, including local bed & breakfasts as well as motels, are not within easy walking distance, but we will provide shuttle service to and from off-campus housing as needed.

First Name:	(please do not enter any punctuations or accents in your name)
Last Name/Surname:	(please do not enter any punctuations or accents in your name)
Gender:	M F
Institution:
Title/Position:
Address:
Email:
Phone:
FAX:
Year Ph.D. received/expected:
Name of Referee:	(Please arrange for one letter of recommendation to be emailed to simonsworkinsti.physics.sunysb.edu)
Selected Publication 1 Title:
Publication 1 URL:
Selected Publication 2 Title:
Publication 2 URL:
Selected Publication 3 Title:
Publication 3 URL:
Brief Statement of Research Interest (Please use line breaks)
URL of CV (if any):
URL of Research Statement (if any):
Proposed Date of Arrival:	/ / 2009
Proposed Date of Departure:	/ / 2009
Will you bring a laptop?	Yes No
Do you expect to have a car?	Yes No
Accommodation Required?	Yes No
if yes, for how many persons?
Preferred Accomodation *	On campus Bed & Breakfast Motel
* Campus dormitory housing will be available for the first two weeks of the workshop. It is convenient though not luxurious. Off-campus housing, including local bed & breakfasts as well as motels, are not within easy walking distance, but we will provide shuttle service to and from off-campus housing as needed.