Annex 1 to the Regulations

Stanisław Lem European Research Prize (Lem Prize)

Application form for candidates

I. CANDIDATE DATA First name(s) Last name Date and place of birth Mailing address Phone number E-mail address Affiliation Position (e.g., assistant, professor) Scientific degree/title (e.g. PhD) Field of science / scientific discipline / research area

II. TITLE OF DISCOVERY OR ACHIEVEMENT (up to 200 characters)

III. DESCRIPTION OF DISCOVERY OR ACHIEVEMENT (attachment; up to 4 pages; may include figures, tables, references, etc.)

IV. DOCUMENTS SUBMITTED WITH THE APPLICATION (Please list below all the documents that will be sent as attachments to the e-mail address lemprize@pwr.edu.pl) … … … … …

I declare that the information contained in the application is consistent with the facts and law. Place, date, signature



INFORMATION CLAUSE ON DATA PROCESSING

For the purpose of fulfilling information obligations specified in the regulations on personal data protection, the University informs you of the following: 

The Controller of Personal Data processed in connection with the competition procedure and the award of the Lem Prize is Wrocław University of Science and Technology based in Wrocław, at Wybrzeże Wyspiańskiego 27, 50-370 Wrocław; you can contact the Controller’s representative via the contact form on the website: http://pwr.edu.pl/kontakt. Wrocław University of Science and Technology has appointed a Data Protection Inspector, who can be contacted at: iod@pwr.edu.pl.

Personal data will be processed in order to enable the candidate to participate in the competition procedure and to award the Lem Prize, on the basis of the consent of the data subject concerned (in accordance with Article 6(1)(a) of the Regulation of the European Parliament and of the Council (EU) 2016/679 (GDPR). Additionally, the basis for the processing may be the necessity to use the data for the purposes arising from the legitimate interests pursued by the controller performing its duties related to the implementation of the procedure for granting the Lem prize.

The processing of personal data will be necessary for the entire period of performing the competition procedure and selecting the winner of the award, but also afterwards – during the period of limitation of potential claims arising therefrom, as well as for archiving purposes for the period specified in regulations on archiving. You can read more about the details of data processing at Wrocław University of Science and Technology in the “Privacy Policy of Wrocław University of Science and Technology” at https://pwr.edu.pl/en/privacy-policy.

The personal data (processed in connection with the performance of tasks financed from public funds) may be disclosed to an appropriate extent under regulations on public information and provided in IT systems or publicly available data filing systems.

The data subject has the right of access to the content of his/her data and the right to rectify, erase or restrict the processing thereof. The data subject shall also have the right to data portability and the right to object to the processing performed by the controller on the basis of the legitimate interest. The data subject – in case the processing violates the provisions of GDPR – has the right to lodge a complaint to the supervisory authority dealing with personal data protection – in Poland it is the President of the Office for Personal Data Protection, whose office is located at: Stawki 2, 00-193 Warsaw.

The processing of personal data is necessary in connection with the acceptance of the candidate's application for the competition. Failure to provide the data by the candidate would mean the inability to accept the application, to evaluate it by the prize committee and to award of the prize, including payment of the money prize.

DECLARATION OF CONSENT TO DATA PROCESSING

* I confirm that I have been presented with the information regarding the processing of personal data entered into the application form in order to select the winner of the Lem Prize. I understand that providing this data is necessary for the above purposes and is voluntary. I acknowledge that the data provided by me, information about the result of the competition and other information related to my candidacy for the award may be disclosed on the website of Wrocław University of Science and Technology and in social media.  I consent to the disclosure and publication of my personal data (including my image) by the Wrocław University of Science and Technology for legitimate purposes of the controller - promotional, informational and related to popularizing science on websites and in the media (including social media).

a box that needs to be checked

Place, date, signature ……