ECODIM APPLICATION FORM
ECOLOGY AND DIVERSITY OF MARINE MICROORGANISMS (ECODIM 2020)
UNIVERSITY OF CONCEPCION
DICHATO 6 – 25 JANUARY 2020

APPLICATION DEADLINE: AUGUST 30, 2019

Email address *
Full Name *
Your answer
Date of Birth *
MM
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DD
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YYYY
City and Country *
Your answer
Postal Address
Your answer
RUT
for Chilean citizen
Your answer
Passport number or identity card number
for foreign citizens (please specify)
Your answer
Undergraduate Studies
Institution *
Your answer
Academic Degree *
Your answer
Start Date *
MM
/
DD
/
YYYY
Finish Date
MM
/
DD
/
YYYY
Graduate Studies
Institution *
Your answer
Academic Degree *
Your answer
Start Date *
MM
/
DD
/
YYYY
Finish Date
MM
/
DD
/
YYYY
Other Graduate Studies
Institution
Your answer
Academic Degree
Your answer
Start Date
MM
/
DD
/
YYYY
Finish Date
MM
/
DD
/
YYYY
Obtained Fellowships
Fellowships
List every fellowship with institution and date
Your answer
Language Skills
English *
Good
Regular
Bad
Reading
Writing
Conversation
Spanish *
Good
Regular
Bad
Reading
Writing
Conversation
Portuguese *
Good
Regular
Bad
Reading
Writing
Conversation
Other Languages
Your answer
Scientific Production
List your publications, thesis, presentations in Congresses and participation in scientific events, as follows:

Title:
Author:
Co-Authors:
Name of journal:
Volume:
Pages:
Date:

Use this format for every category, separating indexation ISI-WoS from the rest.

Scientific Production
Your answer
Academic Distinctions
List academic distinctions with (Institution, Date)
Your answer
Affiliations
List affiliation to scientific Institutions and Organizations with (Name of the Institution/Organization, Incorporation Date)
Your answer
Letter of Intention
Letter of Intention *
Write a 500-word (maximum) letter of intention with details on why you are interested in participating in ECODIM 2020 and indicate why your attendance will impact your scientific career and future research. Use the space provided.
Your answer
Scientific Interests *
Briefy detail your main scientific interests (maximum 3). Use the space provided
Your answer
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