Outils personnels
FUNDP > Recherche > Services > Financement > RegionWallonne > declaration_intention
 

declaration_intention

iwinomat2_declaration_intention.php.htm — HTML, 6Kb

Contenu du fichier

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="fr" lang="fr"><head><title>Programme Winnomat 2 - Formulaire de d�aration d'intention</title>



<meta http-equiv="Content-type" content="text/html; charset=iso-8859-1">
<link rel="stylesheet" type="text/css" href="iwinomat2_declaration_intention.php_fichiers/winnomat2.css"></head><body>
<div id="entete">
<h1>Winnomat 2</h1>
<h2>Formulaire de d�aration d'intention</h2>
<h3>Les informations figurant dans le pr�nt document seront rendues publiques via le Portail de la Recherche et des Technologies.</h3>
</div>
<div class="formulaire">
<form action="intention.php" method="post">
<div class="ligne">
<span class="nomchamp">Acronyme (obligatoire, 10 caract�s maximum) :</span>
<span class="champ"><input name="acronyme" class="contenuchamp" maxlength="10" type="text"></span>
</div>
<div class="ligne">
<span class="nomchamp">Titre du projet :</span>
<span class="champ"><textarea class="contenuchamp" cols="48" rows="4" name="titreprojet"></textarea></span>
</div>
<div class="ligne">
<span class="nomchamp">Dur�(en mois) :</span>
<span class="champ"><input name="duree" class="contenuchamp" maxlength="2" type="text"></span>
</div>
<div class="ligne">
<span class="nomchamp">Pr�m du promoteur :</span>
<span class="champ"><input name="prenompromoteur" class="contenuchamp" maxlength="32" type="text"></span>
</div>
<div class="ligne">
<span class="nomchamp">Nom du promoteur :</span>
<span class="champ"><input name="nompromoteur" class="contenuchamp" maxlength="32" type="text"></span>
</div>
<div class="ligne">
<span class="nomchamp">Unit�u promoteur :</span>
<span class="champ"><input name="unitepromoteur" class="contenuchamp" maxlength="64" type="text"></span>
</div>
<div class="ligne">
<span class="nomchamp">Institution du promoteur :</span>
<span class="champ">
<select name="institutionpromoteur" class="contenuchamp">
<option value="37">Universit�ibre de Bruxelles</option>
<option value="36">Universit�e Mons-Hainaut</option>
<option value="35">Universit�e Li�</option>
<option value="34">Universit�atholique de Louvain</option>
<option value="30">Haute Ecole Roi Baudouin</option>
<option value="29">Haute Ecole Robert Schumann</option>
<option value="28">Haute Ecole Rennequin Sualem</option>
<option value="27">Haute Ecole Provinciale de Charleroi - Universit�u Travail</option>
<option value="26">Haute Ecole Paul Henri Spaak</option>
<option value="25">Haute Ecole Mosane d'Enseignement Sup�eur</option>
<option value="24">Haute Ecole Lucia de Brouck�</option>
<option value="23">Haute Ecole L�ard de Vinci</option>
<option value="22">Haute Ecole de la Communaut�ran�se du Hainaut</option>
<option value="21">Haute Ecole Charlemagne</option>
<option value="20">Haute Ecole Blaise Pascal</option>
<option value="19">Facult�Universitaires Notre Dame de la Paix</option>
<option value="18">Facult�Universitaires Catholiques de Mons</option>
<option value="16">Facult�niversitaire des Sciences Agronomiques de Gembloux</option>
<option value="17">Facult�olytechnique de Mons</option>
</select>
</span>
</div>
<div class="ligne">
<span class="nomchamp">Adresse du promoteur :</span>
<span class="champ"><textarea class="contenuchamp" cols="48" rows="4" name="adressepromoteur"></textarea></span>
</div>
<div class="ligne">
<span class="nomchamp">Pr�m du coordinateur scientifique :</span>
<span class="champ"><input name="prenomcoordinateur" class="contenuchamp" maxlength="32" type="text"></span>
</div>
<div class="ligne">
<span class="nomchamp">Nom du coordinateur scientifique :</span>
<span class="champ"><input name="nomcoordinateur" class="contenuchamp" maxlength="32" type="text"></span>
</div>
<div class="ligne">
<span class="nomchamp">E-mail du coordinateur scientifique :</span>
<span class="champ"><input name="emailcoordinateur" class="contenuchamp" maxlength="64" type="text"></span>
</div>
<div class="ligne">
<span class="nomchamp">Confirmation de l'e-mail du coordinateur scientifique :</span>
<span class="champ"><input name="confirmationemailcoordinateur" class="contenuchamp" maxlength="64" type="text"></span>
</div>
<div class="ligne">
<span class="nomchamp">Num� de t�phone du coordinateur scientifique :</span>
<span class="champ"><input name="telephonecoordinateur" class="contenuchamp" maxlength="32" type="text"></span>
</div>
<div class="ligne">
<span class="nomchamp">R�m�u projet (4096 caract�s maximum) :</span>
<span class="champ"><textarea class="contenuchamp" cols="48" rows="8" name="resume"></textarea></span>
</div>
<div class="ligne">
<span class="nomchamp">Premier partenaire pressenti (pr�m, nom, unit�t institution) :</span>
<span class="champ"><textarea class="contenuchamp" cols="48" rows="4" name="partenaire1"></textarea></span>
</div>
<div class="ligne">
<span class="nomchamp">Deuxi� partenaire pressenti (pr�m, nom, unit�t institution) :</span>
<span class="champ"><textarea class="contenuchamp" cols="48" rows="4" name="partenaire2"></textarea></span>
</div>
<div class="ligne">
<span class="nomchamp">Troisi� partenaire pressenti (pr�m, nom, unit�t institution) :</span>
<span class="champ"><textarea class="contenuchamp" cols="48" rows="4" name="partenaire3"></textarea></span>
</div>
<div class="ligne">
<span class="nomchamp">Quatri� partenaire pressenti (pr�m, nom, unit�t institution) :</span>
<span class="champ"><textarea class="contenuchamp" cols="48" rows="4" name="partenaire4"></textarea></span>
</div>
<div class="ligne">
<span class="nomchamp">Premier parrain industriel pressenti (nom de l'entreprise, pr�m et nom de la personne de contact) :</span>
<span class="champ"><textarea class="contenuchamp" cols="48" rows="4" name="parrain1"></textarea></span>
</div>
<div class="ligne">
<span class="nomchamp">Deuxi� parrain industriel pressenti (nom de l'entreprise, pr�m et nom de la personne de contact) :</span>
<span class="champ"><textarea class="contenuchamp" cols="48" rows="4" name="parrain2"></textarea></span>
</div>
<div class="ligne">
<span class="nomchamp">Troisi� parrain industriel pressenti (nom de l'entreprise, pr�m et nom de la personne de contact) :</span>
<span class="champ"><textarea class="contenuchamp" cols="48" rows="4" name="parrain3"></textarea></span>
</div>
<div class="ligne">
<span class="nomchamp">Quatri� parrain industriel pressenti (nom de l'entreprise, pr�m et nom de la personne de contact) :</span>
<span class="champ"><textarea class="contenuchamp" cols="48" rows="4" name="parrain4"></textarea></span>
</div>
<div class="ligne">
<span class="boutons"><input name="envoyer" value="Envoyer �a DGTRE" class="boutonenvoi" type="submit"></span>
<input name="etape" value="envoi" type="hidden">
</div>
<div class="spacer">
&nbsp;
</div>
</form>
</div>
</body></html>