Dutch Kidney Foundation

Application form

Kolff Student Fellowship Abroad Grant

Version 6 December 2017

The Dutch Kidney Foundation (DKF) General Funding Conditions (‘'Subsidievoorwaarden Nierstichting Nederland'') apply to all awarded DKF subsidies as well as all proposals for DKF subsidies. Applicability of general and other conditions of the applicant, the applicant's institute and of third parties is explicitly excluded.

The execution of a DKF Call for proposals, selection of pre-proposals for full application and positive DKF grant award decisions are conditional on DKF revenues and budgetary means. The DKF explicitly reserves the right to cancel an initiated Call for proposals, to suspend a running procedure or to lower a grant amount in relation to earlier statements.

Dutch Kidney Foundation

Nierstichting

+31 (0) 35 697 8011

Project code: ______

This code will be assigned by the DKF after receiving your application.

Please submit in digital format only (PDF).

Word counts given below are indications for the preferred maximal length of text.

Application date: ______

1. Title

2. Applicant, Project Leader in the Netherlands

Name (M/F)
Institute & Department
Address:
Name Institute Department
Room number
Street name
Postal code,Town/city
Telephone
E-mail
Project leader of DKF Projects (project codes past 4 years if applicable)

3. Student Fellow

Name (M/F)
Address (NL):
Street name
Postal code,Town/city
Address abroad:
Street name
Postal code, Town/city Country
Telephone (NL)
E-mail
Date of birth
University (NL)
Study
Bank account (NL): bank name, account number, account holder

4. Project Leader Abroad

Name (M/F)
Institute & Department
Address:
Name Institute Department
Room number
Street name
Postal code, Town/city
Country
Telephone
E-mail

5. Student Research Project

Expected start date
Expected end date
Duration
Proposed DKF Budget

6. Overall Research Project Abroad

Provide information of the project to which the Student Fellow will contribute.

Title
Project code
Project leader
Country, institute and department
Funder of the project
Start date and duration

7. Summary of the Overall Research Project (max. 400 words)

8. Student Fellow Research Project (max. 500 words)

Describe the project and how it fits within the overall project. Include hypothesis, objectives, work plan and time schedule.

9. Summary of the Research of the Supervisor Abroad (max. 400 words, max. 10 references)

10. Motivation of the Student Fellow

Written by the candidate.Motivate your application for a Kolff Student Fellowship Abroad Grant. Also address your personal motives and your plans in nephrology and renal research.

11. CV of the Student Fellow

Written by the candidate.

12. Budget

12.1 Cost Estimate

Expenses: travel expenses (single entry and return) and/or extra costs of living (accommodation and visa) / Costs (in euros)
-
-
-
…

12.2 Acquired Grants

List the grants that areacquired(or expected) for the purpose of this fellowship

Grants: study grants, scholarships, prizes, reimbursements etc. / Budget (in euros)
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-
-
…

13. Signatures

The project leader abroad signs the letter of invitation.

Name, position, institute / Signature / Date
Project leader (NL)
Student fellow
Authorized Head of Institute (NL)