Institute of Medical Ethics

2018 Application form for Intercalated Scholarships

Please read the guidelines before completing this form.

Surname: / First name: / Male/Female:
Permanent (home) address: / Term time address:
Home tel no: / Term tel/mobile no:
Permanent e-mail: / College e-mail:
University/Medical School:
Year of study (ie 2nd,4th etc) / Name and university e-mail of referee
[See 3(v) of guidelines]
If you are successful we will make a bank transfer once you have been notified. Please give details of the relevant bank account (Address, Sort code and Account Number):
How did you find out about this award?
Title of intercalated degree: / Have you been accepted for your chosen course? If not when do you expect to be told? [See 9 of guidelines]
Date of commencing your intercalated degree: / University/Medical School at which you will doing your degree (if different from your home institution):
Please indicate whether you have applied for scholarship funding elsewhere. If so, please specify:
Title of your project/special interest:
Please provide an outline of your project/special interest using the following five headings: [See 3(iii) of guidelines] [Please keep within the space provided]
Before completing this section you are strongly advised to refer to the guidelines ‘Research methods in medical ethics’ which is available on the IME website.
What is the aim of your project/special interest? What question(s) do you hope to answer?
Background of the project/special interest
Why do you think this is an important topic? Why do you want to explore it? Use references to support your claims.
Describe the methods you will be using.
Will these answer your question? Is your project/special interest feasible?
What might be the relevance of your findings?
To health care? To the medical ethics debate? To your future career?
References (Maximum 8)
Outline continued:
Statement: [See 3(iv) of guidelines]
CV: [See 3(ii) of guidelines]
CV continued:
Signature (Student):
Date: / Signature (Member of staff who completed the reference below):
Name of signatory:
Does this project require ethical approval? Yes/No
If so, to whom has this application been made?
Official university stamp:
If your application is successful the IME may wish to publish your report on our website. Please indicate opposite. / Please delete as appropriate:
I agree/do not agree to publication.
Signed:

Last reviewed: August 2017

Award of Intercalated Scholarships: Reference request [See 3(v) of guidelines]

The Institute of Medical Ethics awards scholarships of up to £2000 each to UK medical undergraduates who intend to do an intercalated degree in medical ethics or a related subject. As part of the assessment of their application we ask the student to provide a reference from a member of staff who is responsible for medical ethics teaching. We would be grateful if you would please complete this form, within the space provided, for:

Name of student:

Please comment on:

1Their overall academic ability:

2Their performance in components of the curriculum related to medical ethics which they may have completed (eg SSCs):

3Their involvement in activities related to medical ethics/law/humanities (eg membership of medical school societies etc):

4Please comment on the student’s proposed project/topic of special interest. Please note that it is strongly recommended that students consult the paper on the IME website ‘Research methods in medical ethics’ before completing their application form.

5Any other information you may feel is relevant to this application:

Name:Position:

Signed:Date: