ABOUT THE APPLICANT
Applicant's: Name	Click or tap to enter text
First Name	Click or tap to enter text
Sciper	Click or tap to enter text
Lab	Click or tap to enter text
Head of Lab Name & First Name	Click or tap to enter text
Expected return date from maternity	Click or tap to enter text

Requested amounts (one year)
Robert Gnehm Grant (RGG)	Click or tap to enter text
RGF (max 10’000 CHF)	Click or tap to enter text
EGA (max 5’000 CHF)	Click or tap to enter text
Lab (min 5’000 CHF)	Click or tap to enter text
Total	Click or tap to enter text

CHOSEN VARIANT
☐ With a (temporary) reduction of the contractual work-rate.
Applicant’s current contractual work rate:	Click or tap to enter text
Adapted contractual work rate:	Click or tap to enter text %.
Start date:	Click or tap to enter text	End date:	Click or tap to enter text
☐ Without reduction of contractual work-rate.
Applicant’s current contractual work rate:	Click or tap to enter text %.

Information on use and expected impact of the RGG
Please describe how the requested amounts will be used.
Click or tap to enter text
If the contractual work rate is reduced (Variant A), please describe specifically how the resources that are made available will be used (i.e. indicate share allocated for the benefit of the postdocs’ project, and concrete use in line with the above mentioned aim).
Click or tap to enter text
Please describe the arrangements between applicant and supervisor/head of laboratory that will ensure a work flexibility resulting in an increased availability for the child (mandatory for variant A / facultative for variant B).
Click or tap here to enter text.

Herewith, I confirm that I accept the conditions and fulfill the requirements set forth in the application guidelines with regard to implication in childcare. Applicant signature

Herewith, I confirm that I accept the conditions of the application guidelines and that I commit to the financial matching. Head of lab signature

Attached documents:

☐	A support letter from the Head of laboratory

☐	For male applicants, justification showing that his partner works at a minimum work rate of 80 % (e.g., copy of work contract or certificate of employer)

☐	Other annexes please specify: Click or tap here to enter text.

Please submit the application forms together with annexes to bureau.egalite@epfl.ch

For example : “the candidate will be able to take care of his/her child on Wednesday afternoon”, “the candidate will not require to take care of cell culture on Saturdays as currently required by her/his project ; this work will be delegated to an assistant financed by the grant”, etc.