Informations personnelles Civilité * - Select -MmeM Nom * Prénom * Email * Adresse * Code Postal * Ville * Pays * Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022 Not eligible for people over 35 years old. Nationalité * - Select -AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong S.A.R., ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Téléphone * Spécialité Pièces Justificatives Lettre de candidature signée par le candidat * Files must be less than 2 MB.Allowed file types: txt pdf doc docx odt. Curriculum Vitae, Exposé des Titres et Travaux * Files must be less than 2 MB.Allowed file types: pdf doc docx odt. N° RPPS (si médecin) Projet de Recherche * Files must be less than 2 MB.Allowed file types: pdf doc docx odt. Template de projet de recherche Télécharger le template Lettre de Recommandation signée du chef de service ou du doyen de la Faculté d’origine * Files must be less than 2 MB.Allowed file types: pdf doc docx odt. Letter of recommendation from the Service Head or from host Laboratory * Files must be less than 2 MB.Allowed file types: pdf doc docx odt. Budget Prévisionnel concernant uniquement le demandeur ( Visa, Billet d'avion eco, Hébergement...etc) * Files must be less than 2 MB.Allowed file types: pdf doc docx odt ppt. Template de projet de budget prévisionnelTélécharger le template Formulaire d'engagement Engagement * I commit to deliver to L'Institut Servier, within the six months following my return, a complete report on my training year, I undertake to come and present my results at the next Laureat's Day dedicated to the theme and I commit to acknowledge in my publication that I received a grant from L’Institut Servier to perform my work. These three undertakings are prerequisites to the obtention of a mobility grant from L'Institut Servier. Engagement Statut * I commit to inform L'Institut Servier, of any change relating to my current status, and especially relating to the obtention of any additional funding or grant to carry out this research work. Règlement * J’ai lu et accepte le Règlement Departure date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202220232024202520262027 Return date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year2022202320242025202620272028202920302031203220332034203520362037 The collected personal data are used to assess your grant application. For more information relating to the data processing and to exercise your rights to access, rectify and delete your personal data, please consult the terms and conditions page. Mobility: Foreign nationals travelling to France - French nationals travelling abroad Age limit for the obtention of the mobility grant: 35 years of age Mobility grant amount: To be determined according to the nature of the candidate's project and the distance to be travelled. Cut-off dates for applications:31st of May (1st session. Responses to be sent to candidates between October and December)31st of October (2nd session. Responses to be sent to candidates between April and June) The full application dossier is submitted to two members of the Scientific Committee for evaluation of the research project* and opinion on the awarding of a grant ; The opinion is validated further to the following meeting of the Scientific Committee. For healthcare professionals practicing in France (including students), If it is decided to award a grant, the dossier will be submitted for approval to the relevant Governing Council. Further to this approval the grant award will be effected. In accordance with the law of the 29th of December 2011, supplemented by the application decree of the 21st of May 2013 and by the law of 26th of January 2016, supplemented by the application decree of the 28th of December 2016, the awarding of the grant will be made public. Leave this field blank Print the form