/ Flinders University
APPLICATION FOR RESEARCH TRAINEESHIP
SCHOOL OF COMPUTER SCIENCE, ENGINEERING AND MATHEMATICS

(To complete electronically, simply use tab key to move from cell to cell)

1 Details of staff member submitting this application.

Title: / Family Name:
Given Name(s):
Department / School / CSEM
Faculty / SCIENCE & ENGINEERING / Position
2 Name and contact details of the proposed trainee.
Title / Family Name:
Given Name(s):
Sex / Male / Female / Date of Birth
Address
Email Address
Completed Awards
(transcripts to be provided if not a Flinders student)
Current Award
University
Progress

3 Inclusive Dates of Initial Proposed training dates:

From / To

4 Description of research project to be undertaken and statement of anticipated benefits to the trainee’s intended future postgraduate study. (Including ambitions and plans for further study)

5 Statutory requirements: Does the research involve any of the following?

a) Importation of experimental organism? / Yes / No
b) Human subjects? / Yes / No
c) Animal experimentation? / Yes / No
d) Deposition of biological material? / Yes / No
e) Genetic Manipulation? / Yes / No
f) Ionising radiation? / Yes / No
g) Social sciences data sets? / Yes / No

If you answer Yes to any of these questions, you must obtain the necessary ethical clearance or otherwise meet the requirements specified in the Guidelines for NHMRC/ARC grants. (For further information on this please contact Office of Research ext 13541.)

Nominating Staff Member’s Authorisation - Statutory requirements

Name: / Signature: / Date:

Certification of the Chairperson of the Ethics Committee ( if required)

Name: / Signature: / Date:

6 Contribution to Living Expenses (Maximum amount of $350 per week in line with current Immigration rules)

Do you wish to make a contribution towards Living Expenses? / Yes / No
If yes, what amount do you wish to pay? / Week / Month
Account Number(s) to be used for Contribution to Living Expenses
0 / 1 / 3 / 9 / 0 / 0 / 3 / 0 / 5 / 4 / 100%
%
%

7 Signature of Staff Member nominating the trainee

Print Name: / Signature: / Date:

8 Approval - Dean of School

I certify that:

• I am satisfied with the academic standing of the person being nominated for the traineeship;

• the trainee can be accommodated within the School;

• the necessary facilities are available to carry out and maintain the proposed research; and

• my office will, upon arrival of the trainee, sight copies of the trainee’s visa and her/his health insurance policy.

Print Name:
JOHN RODDICK / Signature: / Date:

10 Approval - Executive Dean of Faculty

Print Name:
WARREN LAWRANCE / Signature: / Date:

Checklist:

Academic transcripts attached (if not Flinders student)
CV attached
Copy of Visa and Passport attached (if international student)

S:\Alladmin\Visiting Scholars\Applications\Research Traineeships\Research_Traineeship_form.doc Page 3 of 3