/ UNIVERSITY OF STELLENBOSCH
FACULTY OF HEALTH SCIENCES /

APPLICATION FORM

SUBCOMMITTEE C POSTDOCTORALFELLOWSHIP AWARDFOR 2012 – 2013

  1. This applicationmust be completed and submitted by the host, together with supporting documentation (comprehensiveCurriculum vitaeof the host) must be submittedin hard copy or electronically to the Division for Research Development (RDSD):
    Dr TBrodovcky, Teaching block Room 5008A, Faculty of Health Sciences, Stellenbosch University, PO Box 19063,TYGERBERG, 7505 by
    20 February 2012.
  2. The total application (excluding the research outputs of the applicant(s) for the last five years and supporting documentation) should not exceed 8 pages.

General information of applicant (host)
Surname
Name
Title
UT number
Telephone number
E-mail
Division / Centre / Unit
Department
Information about the proposed research project
TITLE OF PROJECT
RESEARCH TEAM(Please indicate who your research team will comprise of for the proposed project. List people that will be involved with this project, including collaborators)
HYPOTHESIS / RESEARCH QUESTION
AIMS & OBJECTIVES(Please supply detailed aims of the research project)
MOTIVATION (Provide a rationale for the research, how it aligns with the Faculty of Health Sciences research thematic areas, why a research fellowship is required and the potential value of the anticipated results)
WORK PROGRAMME (Provide an indication of the anticipated programme of work per year of the project. Please indicate the goals, methodology, timeframes and envisaged outputs)
INFRASTRUCTURE (Please indicate the availability of the required infrastructure, e.g. instrumentation, work station, access to computers, etc.)
FINANCIAL SUPPORT TO PROJECT OPERATIONAL COSTS(Please indicate all sources and amounts of project funding which have been allocated, as well as all sources and amounts applied for with the outcome still pending)
FUNDS ALREADY ALLOCATED TO PROJECT:
SOURCE AMOUNT
FUNDS APPLIED FOR PROJECT, PENDING OUTCOME:
SOURCE AMOUNT
ALL RESEARCH OUTPUTS DURING THE PAST FIVE YEARS
(Please provide your research outputs below OR in a separate annexure. List under the headings provided and provide full references for each)

1.PAPERS PUBLISHED IN PEER-REVIEWED JOURNALS

2.PAPERS SUBMITTED FOR PUBLICATION

3.PAPERS IN NON-REFREED JOURNALS

4.BOOKS AND CHAPTERS IN BOOKS

5.REFEREED FULL-LENGTH PAPERS IN PROCEEDINGS OF INTERNATIONAL CONFERENCES/SYMPOSIA

6.REFEREED FULL LENGTH PAPERS IN PROCEEDINGS OF NATIONAL CONFERENCES/SYMPOSIA

7.PRESENTATIONS AT INTERNATIONAL CONFERENCES/SYMPOSIA

8.PRESENTATIONS AT NATIONAL CONFERENCES/SYMPOSIA

9.OTHER RESEARCH REPORTS AND GENERAL

10.PATENTS

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Signed Date

SU FHS: Subcommittee C Postdoctoralfellowship application 20121