INVOLVED LE STUDIUM FELLOW

Last Name

First Name

Email

Other involved fellow

SECOND INVOLVED LE STUDIUM FELLOW

Last Name

First Name

Email

INVOLVED HOST SCIENTIST

Last name

First name

Email

Other involved host scientist

SECOND INVOLVED HOST SCIENTIST

Last name

First name

Email

INVOLVED REGIONAL RESEARCH CENTRES

PROPOSED EVENT

Proposed Title

Proposed date(s) for the event

Key words

Scientific scope of the event (About 200 words)

Interdisciplinary dimension (About 200 words)

Strategic objectives for the fellow(s) / host scientit(s) / project (About 200 words)

Expected impact of the event in the regional R&I ecosystem (About 200 words)

Format of the event (between 1 and 5 days)

Expected number of participants

Potential invited speakers (with their institution and country)

ESTIMATED BUDGET

Heading	Amount	Situation
Research Centre Contribution		Validated In progress To ask
		Validated In progress To ask
		Validated In progress To ask
		Validated In progress To ask
		Validated In progress To ask
Requested Le Studium Contribution
Proposed registration price
Total estimated budget

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