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European Forum Alpbach 2016

New Enlightenment
17.08.–02.09.2016

We kindly ask you to fill in this form electronically and send us the print-out with your application.

Application Form for Scholarships Please send documents like reports, diplomas and certificates as copies only.
Deadline for scholarship application: March 31, 2016 (postmark)

Contact Information Female Male

Surname First name Title

University
or Company*

Field of study
or Position*

Date of birth . . Place of birth Nationality

Passport no /
Social security no.** Correspondence German English

Emergency Contact

Name Phone E-Mail

Main place of residence** Address during the academic year (not the address of your university)
only if different from main place of residence

Address Address

Country Post Code City Country Post Code City

Phone Fax Phone Fax

E-Mail*** E-Mail***

Registration
Please choose only those events, seminars and working groups which you really intend to attend and that will not take place at the same time.

Seminar Week (17.–23.08.) Seminar and

Summer School European Health Care and Social Systems in Transition (17.–25.08.), English-speaking Course
You have the option of extending your stay beyond the duration of the Summer School (from 26.08.2016 on) and to attend the events of the
European Forum Alpbach 2016. If you wish to do so please tick your choices below.

Euregio Symposium (20.–21.08.) Political Symposium (28.–30.08.) Breakout Session and

Health Symposium (21.– 23.08.) Partner Session Legal Symposium (28.– 30.08.) Breakout Session and

Higher Education Symposium (24.08.) Economic Symposium (30.08.–01.09.) Breakout Session and

Technology Symposium (25.– 27.08.) Breakout Session Financial Market Symp. (01.– 02.09.) Breakfast Club and

Built Environment Symposium (01.– 02.09.)

Please note that you can only apply either for the Seminar Week or for the Summer School on European Health Care.
Your well-considered choice of events gives evidence of your knowledge of the programme and enables us to estimate room requirements.

If you do not plan to stay for the entire European Forum Alpbach 2016,
please inform us about the duration of your participation. Participation from . to . .

Remarks

Place, date Signature

*We ask you to indicate your passport no. or social security no. for accounting procedures with donors, reporting to the Austrian Education Register and to be able to support you in visa affairs.
**Please indicate your home residence, as some scholarships are reserved for persons from distinct regions (e.g. Danube region, etc.).
***Please avoid hotmail or outlook addresses, as we have experienced numerous problems with delivery. Please also check your spam folder regularly.

European Forum Alpbach Non-Profit Foundation under Private Law

Franz-Josefs-Kai 13/10, 1010 Vienna, Austria T +43 (1) 718 17 11 F +43 (1) 718 17 01 E stiftung@alpbach.org W www.alpbach.org forumalpbach
Erste Bank Oesterreich IBAN AT59 2011 1284 5896 8200 BIC GIBAATWW Seat Vienna, FN 267266 f, Commercial Court Vienna