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ANMLAN OM DISPUTATION | ENROLMENT OF DISPUTATION Doktorandens

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ANMÄLAN OM DISPUTATION | ENROLMENT OF DISPUTATION
Doktorandens efternamn och förnamn | PhD student's last name and first name
E-postadress | E-mail address
Personnummer | Swedish personal identity number
Institution, avdelning/sektion | Institute, department
E-postadress | E-mail address
Institution | Institute
E-postadress | E-mail address
Namn och titel | Name and title
Institution | Institute
E-postadress | E-mail address
Sahlgrenska akademins kansli, uppdaterad mars 2019 1 (3)
Avhandlingens titel | Title of the thesis
Om delarbetena utnyttjas i annan avhandling eller licentiatuppsats ska handledare redovisa för varje disputands
insats och hur deras arbetsuppgifter särskiljs. | If the articles are included in another PhD or licentiate thesis,
the supervisor must explain for each PhD student's work and how their work is separated.
Antal ingående delarbeten |
Number of articles included
Datum, tid och lokal | Date, time and venue
Dnr:
Grundexamen | Basic education
Yrkeslegitimation och datum för utfärdande |
Professional certification and date of issue
Avsedd examen | Intended degree
Medicine doktorsexamen | Degree of Doctor of Philosoph
Odontologie doktorsexamen | Degree of Doctor of Philosophy (in Dental Science)
Filosofie doktorsexamen | Degree of Doctor of Philosophy
Farmacie doktorsexamen | Degree of Doctor of Philosophy (in Pharmaceutical Science)
Forskarutbildningsämne | Research subject area
Utnyttjas någon/några delarbeten i annan licentiatuppsats eller avhandling? Ange antal |
Are any articles included in another licentiate thesis or PhD thesis? How many?
Ja | Yes
Hur många | How many?
Monografiavhandling | Monography
Nej | No
Namnförtydligande | Clarification
Datum och underskrift av huvudhandledare |
Date and signature by the principal supervisor
Biträdande handledare | Assistant supervisor
Biträdande handledare | Assistant supervisor
Sahlgrenska akademins kansli, uppdaterad mars 2019 2 (3)
E-post till huvudhandledare | E-mail to prin
cipal supervisor
Biträdande handledare | Assistant supervisor
Doktorandens personnummer | PhD student's Swedish personal identity number
INTYG | CERTIFICATE
Härmed intygas | Hereby certifies
1. att ovanstående doktorand författat nämnda avhandling. |
that the above mentioned PhD student has written the cited thesis.
2. att samtliga ledamöter i betygsnämnden, opponenten och ordföranden vid disputationsakten har blivit tillfrågade
och accepterat uppdraget. Jävsfrågan mellan betygsnämnd, opponent samt ordförande vid disputationsakten och
doktorand respektive handledare har beaktats. |
that all members of the examining committee, the opponent, the chairperson of the disputation have been asked and
accepted the assignment. Conflicts of interest between the examining committee, the opponent, the chairperson of the
disputation and the PhD student and his/her supervisors have been considered.
FÖRESLAGEN OPPONENT | PROPOSED OPPONENT
Namn, titel, lärosäte, institution, stad, land, e-postadress | Name, title, university, institute, city, country, e-mail address
FÖRESLAGEN ORDFÖRANDE FÖR DISPUTATIONSAKTEN | PROPOSED CHAIRPERSON OF THE PhD
EXAMINATION
Namn, titel, avdelning/sektion, institution, e-postadress | Name, title, department, institute, e-mail address
Doktorandens personnummer | PhD student's Swedish personal identity number
FÖRESLAGNA LEDAMÖTER I BETYGSNÄMNDEN | PROPOSED MEMBERS OF THE EXAMINING COMMITTEE
Betygsnämnden ska bestå av tre eller fem ledamöter och vara sammansatt enligt Sahlgrenska akademins regler och
rutiner. | The examining committee shall consist of three or five members and be constituted according to the rules
and routins of Sahlgrenska Academy.
Betygsnämnden ska i sitt beslut intyga att det för dess sammansättning och förhållande mellan dess ledamöter,
opponent, samtliga handledare och doktorand inte föreligger några jäv enligt föreskrifter i förvaltningslagen (SFS
2017:900 §§ 16-18) | The examining committee shall certify in its decision that there are no conflicts of interest
between the members of the examining committee, the opponent, the supervisors and the PhD student in accordance
with the regulations in the Administrative Procedures Act (SFS 2017:900 §§ 16-18).
Ledamot 1, namn och titel | Member 1, name and title
Ledamot 2, namn och titel | Member 2, name and title
Ledamot 3, namn och titel | Member 3, name and title
Ledamot 5, namn och titel | Member 5, name and title
Avdelning, lärosäte, stad | Department, university, city
Avdelning, lärosäte, stad
| Department, university, city
Avdelning, lärosäte, stad | Department, university, city
Avdelning, lärosäte, stad | Department, university, city
E-postadress | E-mail address
Telefon | Phone
Ledamot 4, namn och titel | Member 4, name and title
E-postadress | E-mail address
E-postadress | E-mail address
Telefon |
Phone
Telefon | Phone
E-postadress | E-mail address
E-postadress | E-mail address
Telefon | Phone
Telefon | Phone
Avdelning, lärosäte, stad | Department, university, city
Datum och underskrift av prefekt | Date and signature by
the head of the institute
Namnförtydligande | Clarification
Sahlgrenska akademins kansli, uppdaterad mars 2019 3 (3)
Den påskrivna blanketten skickas till | Please send the signed form to
Sahlgrenska akademins k
ans
l
i
U
t
b
i
l
d
n
i
n
g på forskarnivå
Box 400
405 30 Göteborg
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ANMLAN OM DISPUTATION ENROLMENT OF DISPUTATION Doktorandens

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Completed 8 March 2021

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