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DWSF Application Form

Please note: keep a copy of your own submission Once you submit your information through this form, you will not automatically receive a copy of what you entered. The submitted data is not sent back to you or stored in a way you can retrieve later.

For your own records (whether for internal accountability within your organization or in case you need to resubmit) we strongly recommend compiling the information you enter into a separate document before or while you fill out the form. This way you always have a record of exactly what was submitted, and when.

Feel free to contact the LNVH bureau at info@lnvh.nl for more information.

Personal Information

First name

Surname

Date of birth

Date of promotion

Is the extension clause applicable?

Scientific discipline

Choose no more than 2 disciplines

Organization

Your position

Work address

Work e-mail

Phone number

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