THE ASSOCIATION OF COMMONWEALTH UNIVERSITIES

TITULAR FELLOWSHIPS 2011

University of Wales Swansea Fulton Fellowship

The Worshipful Company of Chartered Accountants in England and Wales Fellowship

Wighton Titular Fellowship in Engineering

The University of Manitoba Fellowship

The George Weston Limited, Canada, Fellowship

The University of Oxford Fellowship

The Jacky McAleer Memorial Fellowship

The Gordon and Jean Southam Fellowship

Please complete this form electronically if possible. Boxes can be expanded if necessary.

1. NAME IN FULL (Please use Block Capitals and underline surname)
2. SEX
3. PLACE AND DATE OF BIRTH
4. ADDRESS (for correspondence about this application; please include fax and e-mail address if known)
5. PRESENT POST AND NATURE OF DUTIES
6. ACADEMIC QUALIFICATIONS (State class, and where and when obtained)
7. BRIEF CURRICULUM VITAE SINCE GRADUATION
(A detailed CV, including publications, may be attached with this application.)
8. WHICH ACU TITULAR FELLOWSHIP ARE YOU APPLYING FOR?
(Please note: candidates who do not identify one of the eight fellowships cannot be considered.)
9. HAVE YOU CONTACTED A POTENTIAL COLLABORATOR OR HOST FOR YOUR FELLOWSHIP?
(If so please provide details, including the name of contact, the extent to which they and their institution have agreed to participate, and any restrictions that they have identified. Please indicate, in no more than 200 words, why this particular collaboration is appropriate. Please note that this information may be verified with the potential collaborator/host before the fellowship is awarded. The application should also include copies of any relevant correspondence with the collaborator.)
10. PROPOSED STUDY PROGRAMME (This item must be completed in full with reference to the competition brochure).
(a)  Country/countries and institution(s) to be visited:
(b)  Title and length of programme:
(c)  Description of programme; please write a brief description of the precise nature of the programme or attachment: (continue on a separate sheet if necessary; maximum 500 words, please.)
(d)  What will be the main benefits of the fellowship? (This can be expressed in terms of your career, your institution, your discipline, or wider society Maximum 300 words.)
11. ESTIMATED COSTS SOUGHT FROM THIS FELLOWSHIP (to be shown, where possible, in Sterling, indicating rate of exchange used. Please note that the maximum award will be £5,000):
(a) international return air fare at the lowest available economy rate and by the most direct route
(b) ground travel to home airport and from airport abroad to final destination
(c) medical insurance
(d) local travel abroad
(e) board and lodging (indicating the number of days upon which the estimate is based)
TOTAL
Are any other organisations contributing to the programme? If so, please give details. (please indicate any contribution from your home institution such as the cost of maintaining your salary).
12. PLEASE GIVE DETAILS OF ANY WORK RELATED STUDY OR OTHER VISITS OUTSIDE YOUR OWN COUNTRY IN THE LAST FIVE YEARS. (including attendance at international conferences)
13. Have you recently APPLIED for any other award in respect of this programme of work? (If so, please give details.)
Signature of applicant Date

14. CONFIRMATION OF SUPPORT FROM HOME INSTITUTION

This section should be completed by the Executive Head or other officer authorised to sign on behalf of your home university, or by the Head of your firm/company, or Chief Executive Officer of the Commonwealth inter-university organisation.

I confirm that I have read this application for an ACU Titular Fellowship and that:

a)  my institution endorses the programme of work proposed;

b)  my institution will, if the applicant is successful, provide the applicant with sufficient leave of absence from his/her duties to fulfil the terms of the award and maintain the applicants salary during that period;

c)  my institution would, if required, be prepared to administrate and account for any funding provided by the ACU for the Fellowship.

Signed / Date
Name
Position
Institution
e-mail

This Application Form should be submitted to in electronic format, to arrive at the Association of Commonwealth Universities by 1st July 2011. Electronic applications must include all relevant signatures and supporting documents and be converted to (and submitted in) PDF format. (We will accept scanned copies of the relevant signature pages).

Hard copies are not necessary, but may be submitted to: ACU Awards (Titular Fellowship), The Association of Commonwealth Universities, Woburn House, 20 – 24 Tavistock Square, London, WC1H 9HF, United Kingdom.