Documentation Centre in Prague
Application form for Researcher-in-Residence Programme
Contacts
Name (surname, given name):

Title (Mr,Ms, PhD candidate) :

Email address: 

Phone/cell number: 

Mailing address:

Research subject 
Title of research project:
(or central research question)

Purpose of research/final deliverable:
(MA/PhD thesis– article – conference paper, etc.):

Expected date for project completion:
(Graduation date, publication deadline, etc.)

Academic/Research affiliation 
Name of University /Institution/ Organization:

Course level (PhD, MA) and name of programme / department (if applicable):

Referee contact or official web page:
(if you wish to submit the contact to a referee we can contact in relation to your application, please state their status and how you are related to them – supervisor, co-author, publisher, etc.)

Booking preferences
Proposed length of research term:
(check with DCiP staff in advance to assess availability of archive materials)

Preferred dates:
(From – to)
___________________________________________________________________________

Date, place and signature: