/ UNIVERSITY OF STELLENBOSCH
FACULTY OF MEDICINE AND HEALTH SCIENCES /

APPLICATION FORM

POSTDOCTORAL FELLOWSHIP AWARD FOR 2013

1.  This application must be completed and submitted by the host, together with supporting documentation (comprehensive Curriculum vitae of the host) must be submitted in hard copy or electronically to the Division for Research Development (RDSD):
Dr T Brodovcky, Teaching block Room 5008A, Faculty of Health Sciences, Stellenbosch University, PO Box 19063, TYGERBERG, 7505 by
1 November 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 all people that will be involved with this project, including collaborators; State each person’s affiliation and role in the project)
HYPOTHESIS / RESEARCH QUESTION
AIMS & OBJECTIVES (Please supply detailed aims of the research project)
MOTIVATION (Provide a rationale for the research, why a research fellowship is required and the significance 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 and underline your name in each case)

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 FMHS: Postdoctoral fellowship application 2013 4