Submission Form • C4W

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Part A | Administrative form

Email*

Gender*

Last Name*

First Name*

Address*

Street Address City ZIP / Postal Code Country

Place of activity of the last 3 years*

From (dd/mm/yyyy)

To (dd/mm/yyyy)

Country

Please list all countries where you have legally resided and/or carried out your main activity (work, studies, etc.) during the 3 years preceding the submission deadline. Add one row per period; short stays (e.g., holidays) should not be included.

Mobility Rule Reminder

You must not have resided or carried out your main activity in Belgium for more than 12 months within the 36 months immediately preceding the call deadline.

Copy of the PhD degree*

Max. file size: 10 MB.

Part B | Project proposal

Project Proposal*

(based on the mandatory C4W project template available the C4W website) – Upload .pdf document*

Accepted file types: pdf, Max. file size: 50 MB.

Proposal Acronym*

Proposal Title*

Cleantech Thematic Panel*

What is the technological or methodological breakthrough of your project, and what major environmental impact does it aim to address?*

Keep it brief: a more in-depth justification of your project’s Cleantech dimension will be required in the full proposal. Expected format: Maximum 3 to 4 sentences (approx. 600 to 800 characters).

Key Research Area*

Research Abstract*

(max. 1000 characters, spaces included)

List of non-grata evaluators (max 5) excluded by the applicant (Name, institution, e-mail address)

List of non-grata evaluators (max 5) excluded by the applicant

Name

Institution

Email address