Formularz zgłoszeniowy

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Apparatus invest form

First and last name of the applicant:

E-mail:

Contact person:

Research group (enumerate members):

Membership of a specific Centre of Excellence or Emerging Field and field (Humanities, Social Sciences and the Arts, Life Sciences, Exact and Natural Sciences):

NCU unit (Faculty, Institute, Department):

Apparatus

Project title / apparatus name:

Investment type / project type (purchase, construction/manufacture, extension – under art. 5 of the Rules):

Planned deadline for implementation/purchase/construction (manufacture):

Funding

Amount requested (PLN):

Total project cost (PLN):

Own contribution (source of funding):

1) Planned material scope of the investment in apparatus:

Name of scientific and research apparatus:

No:

Planned unit outlay:

Total outlay:

Total:

2) Description of the planned material scope, including reasons for the planned outlay (in the case of extension or modernization, provide information on the ownership title of the scientific and research apparatus which is subject to the extension and the attached statement as to its value):

3) List including a description of scientific research or development works and other activities for which the planned apparatus is relevant, particularly with regard to their significance for the implementation of the activities under the IDUB programme and for the development of national and international collaboration in science:

4) Planned outputs of works and research tasks carried out with the use of the requested apparatus and their relevance for the development of the EF/CE and the NCU; indicate the innovativeness of the planned research:

5) Information on the applicant's scientific achievements linked to the planned investment evidencing the period of 4 years preceding the submission of the application (publications, patents, grants or other - maximum 20 items):

6) Possibility for other entities to use the requested apparatus when it is made available to these entities or in the course of the applicant's collaboration with these entities:

7) Information about the lack of access to the requested apparatus at the University; uniqueness of the apparatus at the NCU level:

8) Preparation of the applicant to carry out the purchase of the apparatus and use the apparatus as well as to cover the costs of using the apparatus and conduct research with its use:

GDPR statement :

(to be downloaded from https://www.umk.pl/idub/mobilnosci/ and signed)