Application and Registration for Admission to the International Max Planck Research School for Neural Circuits

* = required fields

Personal Information

*	Last name
*	First name
	Middle name(s)
*	Date of birth	Year: Month: Day:
*	Place of birth (city / country)
*	Nationality
*		Male Female
*	E-mail address	Please fill in only one email-address!

Address

*	Street
*	Postal zip code
*	City
	State (if applicable)
*	Country
*	Telephone number
	Fax number (if applicable)

Education

*	What is your background?	neuroscience mathematics physics computer science (bio) chemistry biology medicine other
	If other, please state

First degree (Master, Bachelor, other)
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*	University/College
*	Dates (from - to)
*	First degree
*	Date (expected)
*	Grade (out of a possible)
*	Name of advisor
*	Subject area of study

Second Degree (Bachelor, Master, other)
..

	University/College
	Dates (from - to)
	Second degree
	Date (expected)
	Grade (out of a possible)
	Name of advisor
	Subject area of study

Main field of interest during your studies

Please name at most three

Scholarships, Awards, Working Experience, Internships, Stay(s) Abroad

Please list scholarships and awards, relevant working experience or internships, stay(s) abroad and any other relevant information

Language Skills

As a sound knowledge of English is inevitable for participation in the program, we ask you to state your proficiency in the English language and give evidence for your skills (e. g. Toefl score, mother tongue, medium of instruction in what courses etc. - give details)

*	English
	Other language skills

Research Experience

Please write the title and an abstract of your research thesis resulting in your most recent degree. Also in the abstract field please indicate the significance, state the number of months of research.

*	Thesis Title
.
*	Abstract of Thesis (max. 400 words)

Letter of Interest

Please explain your interest in this Graduate Program by stating your research interest, your interest in interdisciplinary approach, a possible research topic and how this topic is related to the interests of the Faculty members and IMPRS (max. 500 words). Please include a word count and note that if your letter of interest is considerably longer than 500 words, your application will not be eligible.

References

Please list below the names, institutions and institutional e-mail addresses of the two referees who have agreed to write a letter of recommendation on your behalf. The database will send an e-mail to the above mentioned referees. We assume you have already informed your referees. Please note that the application deadline is also for the references.

	Referee no. 1
*	Name
*	Institution
*	E-Mail	Please fill in only one email-address!
.
	Referee no. 2
*	Name
*	Institution
*	E-Mail	Please fill in only one email-address!

Doctoral Research Focus

	IMPRS for Neural Circuits host institution and Faculty member ..
*	Please indicate four participating Faculty members who can evaluate your application and where you would like to conduct your research. Please consult the IMPRS for Neural Circuits website for further information. http://www.imprs.brain.mpg.de
..
	Prof. Dr. Erin Schuman (Max Planck Institute for Brain Research) Prof. Dr. Dr. Gilles Laurent (Max Planck Institute for Brain Research) Dr. Moritz Helmstaedter (Max Planck Institute for Brain Research) Prof. Dr. Dr. h. c. mult. Wolf Singer (Max Planck Institute for Brain Research) Dr. Tatjana Tchumatchenko (Max Planck Institute for Brain Research) Dr. Johannes Letzkus (Max Planck Institute for Brain Research) Dr. Hiroshi Ito (Max Planck Institute for Brain Research) Dr. Julijana Gjorgjieva (Max Planck Institute for Brain Research) Prof. Dr. Ernst Bamberg (Max Planck Institute of Biophysics) Prof. Dr. Werner Kühlbrandt (Max Planck Institute of Biophysics) Prof. Dr. Amparo Acker-Palmer (Goethe University) Prof. Dr. Manfred Kössl (Goethe University) Prof. Dr. Georg Auburger (Goethe University) Prof. Dr. Thomas Deller (Goethe University) Dr. Andreas Vlachos (Goethe University) Prof. Dr. Jochen Roeper (Goethe University) Dr. Torfi Sigurdsson (Goethe University) Prof. Dr. Alexander Gottschalk (Goethe University) Prof. Dr. Gabriel Wittum (Goethe University) Prof. Dr. Pascal Fries (Ernst Strüngmann Institute) Dr. Hermann Cuntz (Ernst Strüngmann Institute / Goethe University) Prof. Dr. Jochen Triesch (Frankfurt Institute for Advanced Studies) Prof. Dr. Matthias Kaschube (Frankfurt Institute for Advanced Studies) Prof. Dr. Christoph von der Malsburg (Frankfurt Institute for Advanced Studies)
.. ..
*	How did you find out about the program (check all that apply)?
	Poster, flyer, posted at/distributed by:
.
	Websites. please specify
.
	Mailing list(s), please specify
.
	Other, please specify (colleagues, friends, conferences, etc.)

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Assurance of Complete and Truthful Information

By submitting this application, I am certifying the complete accuracy and truthfulness of all information stated herein. I am aware that untruthful answers, whether intentional or the result of negligence, could lead to the revocation of my admission. I consent to the storage of my personal data for application and admission purposes.

Please note that you cannot change your data once it has been submitted!

You will receive a confirmation email if your registration is successful.

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This registration system has been created by S. Greber and W. Grieger, GWDG, Göttingen.