Zentrum für Neurowissenschaften Zürich (ZNZ) Neuroscience Center Zurich

APPLICATIONfor Reimbursement of Transportation Cost

to Ph.D. Students of the ZNZ

Please write in block lettersFamily Name of Applicant First Name of Applicant Academic Title of Applicant

Name of Institute / Clinic Institute’s Address Home Address

Phone Fax E-mail Congress Title Congress Place Congress Date

Reasons why you wish to participate / complete list of expenses

Own presentation yes If yes, which kind of presentation:

no presentation

AMOUNT REQUESTED from ZNZ(Max. CHF 1.000 per person and year) CHF

Other financial contributions (applied for, warranted or obtained)(name of foundations, sponsors)

Postal/Bank Account No. of Person/Institue who should be refunded:

Bank's Address

Signature Applicant Date Signature ZNZ Group Leader Date accepted by the ZNZ:Date

rejected by the ZNZ:Date

Please return application form to: ZNZ - Zentrum für Neurowissenschaften Zürich,Winterthurerstrasse 190, 8057 Zürich, Building 55 H 72 or 70 Conditions - p.t.o.

Conditions for Reimbursement of Travel Expenses

The ZNZ can reimburse travel expenses of ZNZ Ph.D. students. The following rules apply:

Travel expenses for congresses, meetings, symposia, workshops or courses can be reimbursed. Only costs for transportation (direct connections) will be reimbursed.

Only Ph.D. students who are registered at the ZNZ and actively take part in the International Ph.D. Program in Neuroscience can apply. All progress reports have to be submitted on time!

A presentation of the student is required except in the case of visits of courses.

Ph.D. students can apply for only one trip per (calendar) year.

Max. CHF 1'000 will be paid per person for one trip per (calendar) year.

Tickets in Economy class for flights and 2nd class railway tickets will be reimbursed after the trip.

Please hand in your application form according to your deadline date before the trip. Deadline dates for applications are:

for congresses in the 1st quarter (Jan – March): 1 Decemberfor congresses in the 2nd quarter (April – June): 1 Marchfor congresses in the 3rd quarter (July – Sept): 1 Junefor congresses in the 4th quarter (Oct– Dec): 1 September

Please hand in the original travel tickets (e.g. boarding passes) and invoices together with the confirmation from your Institute (see attachment) after your trip. If you not have the original tickets or boarding passes we will not reimburse your costs.

The ZNZ will notify the applicant shortly after the submission of the application form about the decision. Reimbursements will be made after the trip as soon as the ZNZ obtains the original tickets.

Please use the ZNZ application form and fill out completely (Word file). Applications will be returned if not filled out completely.

Confirmation

We hereby confirm that

Name Surname

was not reimbursed for travel expenses by our Institute for: Congress Title, Place & Date

Stamp of Institute

Date:

Signature:

I hereby confirm that I did not receive any other financial support for travel expenses to the above mentioned congress by other Institutions.(If you got other travel grants please attach a copy of the proof of payment.)

To be signed by the Ph.D. Student:

Date:

Signature:

04 October 2010, ch