Student Research Elective Research Training Support

Received on: / Ref. No:

FELLOWSHIP APPLICATION 2017

Application’s type

Student Research Elective Research Training Support

Applicant’s details

Surname
First Name
Academic Title (if any)
Date of birth
Gender
UAE passport number
National document number (Khulasat AlQayd)
E-mail
Mobile
Post address
Current employment (if applicable)
Title of current post
Employer
Date of appointment/start date
End date of contract (if applicable)
Total salary (including basic salary)
If salary is funded from more than one source, please specify
Employment history (most recent first, if applicable)
From / To / Position / Department / University/
Institution
Education/training, and professional body membership
Date (mm/yyyy) / Degree (if applicable) / Subject / University/Institution
Clinical Status (if applicable)
Are you clinically trained? / Yes No
Are you clinically active? / Yes No
What is your specialty?
Summary of academic/clinical career to date, including key achievements, prizes (state year of award) and any previous research experience (no more than 250 words. Calibri style, font size 11).
Please list all your publications, including original research publications and other scholarly contributions (if applicable). Publications should be in chronological order with the most recent first. Please give citation in full, including title of paper and all authors.

Detail of proposal

Please explain why you wish to pursue a Fellowship at the chosen institute and elaborate how this will further your career (no more than 500 words, Calibri style, font size 11).
Supervisor (s) at home institution
Supervisor and position
Department, Institution and contact (email & phone)
Supervisor and position
Department, Institution and contact (email & phone)
Location for the fellowship
Department:
Institution:
City:
Country:
Starting date of Fellowship:
Details of supervisor(s)
Supervisor and position
Department, Institution and contact (email & phone)
Supervisor and position
Department, Institution and contact (email & phone)
Supervisor and position
Department, Institution and contact (email & phone)
Please describe role of the supervisor(s)
Summary of proposed fellowship including key scientific goals and methods
If you have already selected a project (no more than 500 words, Calibri style, font size 11).
Indicate what your research question is, and why it is important. Detail (a) Aims of the project, (b) Work which has led up to the project, (c) Timetable and milestones, (d) What key methodologies and techniques will be used. Provide a maximum of 20 key references.
Graphs, figures and supporting unpublished data may be embedded in the text
Requested budget
SN / Categories / Amount requested (AED)
1 / Travel tickets (Economy class)
2 / Registration & tuition/training fees
3 / Health insurance (Limited to AED 10,000)
4 / Visa application fees
5 / Living expenses
6 / Any other expenses (please itemize)
1.
2.
3.
4.
TOTAL (AED)

Application check list

·  Application form

·  Copy of UAE passport, Emirates ID and Khulasat Al – Qayd

·  Resume

·  Letter of recommendations

·  Letter of consent from home institution/employer

·  Copy of employment certificate (if applicable)

·  Acceptance letter from host institution

Signature (Applicant): ______Date of Submission: ______