Call for proposals UNIFI4FUTURE

Annex 1 APPLICATION FORM

1.	Personal Data

Last Name                                                                                                                                                                                                                                                                                                      First Name 

Tax Code, if any

Nationality        Date of Birth (DD/MM/YYYY) 

Country of Birth                                                 Country of residence

Current address

E-mail                                                                          Phone

PhD qualification                                                                       

Issued by

Date of award

Title of Doctoral Thesis

2.	Curriculum Vitae (max. 2 pages):

PERSONAL INFORMATION
Family name, First name:
Researcher unique identifier(s) (such as ORCID, Research ID, etc. ...):
Date of birth: 
Nationality: 
URL for web site: 		

EDUCATION
200? 	PhD
	Name of Faculty/ Department, Name of University/ Institution, Country
	Name of PhD Supervisor
199? 	Master
	Name of Faculty/ Department, Name of University/ Institution, Country
	 
CURRENT POSITION(S)
201? –	Current Position
		Name of Faculty/ Department, Name of University/ Institution/ Country
200? – 	Current Position
		Name of Faculty/ Department, Name of University/ Institution/ Country

PREVIOUS POSITIONS
200? – 200? 	Position held 
			Name of Faculty/ Department, Name of University/ Institution/ Country
200? – 200? 	Position held
			Name of Faculty/ Department, Name of University/ Institution/ Country

FELLOWSHIPS AND AWARDS
200? – 200? 	Scholarship, Name of Faculty/ Department/Centre, Name of University/ Institution/ Country 
200?		Award, Name of Institution/Country
199? – 199? 	Scholarship, Name of Faculty/ Department/Centre, Name of University/ Institution/ Country

TEACHING ACTIVITIES (if applicable) 
200? – 		Teaching position – Topic, Name of University/ Institution/ Country
200? – 200? 	Teaching position – Topic, Name of University/ Institution/ Country

ORGANISATION OF SCIENTIFIC MEETINGS (if applicable)
201?	Please specify your role and the name of event / Country 
200? 	Please specify type of event / number of participants / Country

INSTITUTIONAL RESPONSIBILITIES (if applicable)
201? – 	            Faculty member, Name of University/ Institution/ Country
201? – 201? 	Graduate Student Advisor, Name of University/ Institution/ Country
200? – 200? 	Member of the Faculty Committee, Name of University/ Institution/ Country 
200? – 200? 	Organizer of the Internal Seminar, Name of University/ Institution/ Country
200? – 200? 	Member of a Committee; role, Name of University/ Institution/ Country

REVIEWING ACTIVITIES (if applicable)
201? – 	Scientific Advisory Board, Name of University/ Institution/ Country
201? – 	Review Board, Name of University/ Institution/ Country
201? –	Review panel member, Name of University/ Institution/ Country
201? – 	Editorial Board, Name of University/ Institution/ Country
200? – 	Scientific Advisory Board, Name of University/ Institution/ Country
200? –	Reviewer, Name of University/ Institution/ Country 
200? –	Scientific Evaluation, Name of University/ Institution/ Country
200? –	Evaluator, Name of University/ Institution/ Country

MEMBERSHIPS OF SCIENTIFIC SOCIETIES (if applicable)
201? –	Member, Research Network “Name of Research Network”
200? –	Associated Member, Name of Faculty/ Department/Centre, Name of University/ Institution/ Country
200? –	Founding Member, Name of Faculty/ Department/Centre, Name of University/ Institution/ Country 

MAJOR COLLABORATIONS (if applicable)
Name of collaborators, Topic, Name of Faculty/ Department/Centre, Name of University/ Institution/ Country
 
CAREER BREAKS (if applicable)
Exact dates	Please indicate the reason and the duration in months.

COVID-19 IMPACT TO SCIENTIFIC PRODUCTIVITY (if applicable) 
Please specify which of the following situations apply to you: 
☐ Increased caring responsibility for dependent person, including home schooling of children;
☐ No access to laboratory facilities, archives, or other necessary facilities;
☐ No access to field work;
☐ Adaptation to online teaching;
☐ Physical and/or mental health issues;
☐Other(s) _________ 

(optional) Explain with objective facts how your productivity was affected by the COVID-19 pandemic. There is a limit of 300 characters, spaces and line breaks included.

3.	
Please include your most important career achievements, including a publication as lead author (requirement for participation in the call) and other relevant publications (max. 10). Publications must be properly referenced, including all authors in the order of publication. Bibliometric indicators relevant to the field may also be included, as well as research monographs and any translations thereof. 
If applicable, include: patents granted; invited presentations at international conferences and/or other events; awards/recognitions/memberships in academies, etc. 
You may include a brief description of the scientific importance of the results of your research activities and your role in them.

Track-record (max. 2 pages)
4.	European projects

Has the applicant been awarded an MSCA Seal of Excellence? If yes, please indicate below the proposal for which it was awarded:

Is/was the applicant participating in funded European projects? If yes, please complete the table below:

Project Title	Programme	Period	Role of the researcher in the project	

Has the applicant submitted project proposals in the framework of calls issued by the European Commission? If yes, please complete the table below:

Proposal Title	Call	Year	Role in the proposal	Evaluation Score	Reference with the current proposal	

5.	Research Project

Title of the project (max. 200 characters)

ERC Panels (min. 1 max. 2 in preferential order, choose from the ERC panels list included on the online application)

CUN Keywords (min. 2 max. 4 in preferential order, choose from the CUN keywords list included on the online application)

Free Keywords (min. 1 max. 10 in preferential order)

Host Department

Abstract (max. 1500 characters)

Project Proposal (max. 8000 characters)