Research Grant Application
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This application must be accompanied by a complete research plan (see research plan page) that should be sent to the Scientific Secretary of EACTA. Without a complete plan the application cannot be processed further.

Research Grant Application

Please fill out this form - click the OK-button and follow the instructions.

Fields with  must be filled in.

 Last Name:
 First Name:
 Title/Position:

Office/Institution:
Department:
Office Address:
City:
State:
Postal Code:
Country:

Tel.:
Fax:
E-mail:

Home Address:
City:
State:
Postal Code:
Country:

Preferred mailing address:

Office
Home

Support from home institution:
(Head of Department/Hospital administrator)

Name:

Institution where the research take plase:

Institution:
Department:
Address:
Zip:
City:
Country:

Contact person at Institution:

Name:
E-mail address:
Fax number:

Reseach start:
Research finish:

Seeking:

Total funding
Partly funding

Specification of needed funding:
(Specified materials, equipment, salary etc and costs. Max. 255 characters)

Specification:

   
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