Application Form

The George Lake Technology Innovation Award

The deadline for applications is the 15th of November of uneven years. Applications shall be submitted electronically with this application form. Applications shall include

An up to 4 pages project description on the scope, methodology and expected short and long term scientific impact;
A brief summary of works previously carried out in the same field demonstrating the skills and experience of the applicant required for the work to be recognized;
A concise CV;
A list of publications during 5 years preceding the application;
A budget plan on how the award will be spent.

The applications are being reviewed and ranked by an expert committee chaired by FONDATION MERAC which will announce the George Lake Technology Innovation Award in the February time scale of the following even year.

Date*

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PRINCIPAL INVESTIGATOR:

Name*

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Title*

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Address*

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Email*

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INSTITUTE:

Name*

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Address*

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Email Institute*

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AGGREGATE SUPPORT: EUR 100,000.00

Institute Wire Information:

Name of Account Holder*

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Bank*

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Street*

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Postcode / Town*

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Country*

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IBAN*

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SWIFT*

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ATTACHMENTS:

Select PDF or DOCX file, max. size 10 mb each

Project Paper*

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Work Summary*

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CV*

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Publications*

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Budget*

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Comments

Ungültige Eingabe

Signature Principal Investigator

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Digital File Ungültige Eingabe

Digital Signature*

Sign Above

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Select JPG or PNG file with signature

Signature*

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Signature Institute

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Digital File Ungültige Eingabe

Digital Signature*

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Select JPG or PNG file with signature

Signature*

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If you have problems with the form, please send us your application by email to This email address is being protected from spambots. You need JavaScript enabled to view it.

For further questions please contact: This email address is being protected from spambots. You need JavaScript enabled to view it.

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