Tittle MrMrsMsDrProf Name Surname

Birthdate Gender: MaleGender: FemaleNationality

Email
University where you teach

Position Department Name and email of Dean of the Faculty

Professional Address

Professional Email

Number of undergrad students in physics

Is there an astronomy course in the curriculum? YN
How many hours per year for the astronomy course? :
How many students register this course?
Are they first year/second year/etc students ?
Which courses do you teach ?
Describe briefly (+/- 10 lines) what you will do after the training with the obtained competences in Astrolab:

This form has to be completed before March 31 2018.
Financial conditions : For the selected participants a grant will be allocated for the travel and the stay.