James H. Simons Workshop in Mathematics and Physics
Stony Brook, July 26 - August 27, 2004.
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)
Institution:
Title/Position:
Address:
Email:
Phone:
FAX:
Year Ph.D. received/expected:
Name of Referee:
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:
Proposed Date of Departure:
Accommodation Required?
Yes
No
if yes, for how many persons?