Application for a Connect Africascholarship

Application for a Connect Africascholarship

Application for a Connect AfricaScholarship

Personal Information
Full Name of Applicant / Citizenship
Category of Scholarship
Date of birth / Gender / Present professional status
Current academic institution / Name of Mentor/Supervisor: / Contact Details of Mentor:
Educational Background
Qualifications / Field of study / University / Year / Distinctions
Work Experience, Courses and Conference Participation(within the last 3 years)
Name of event / Details / Dates
Awards
Name of Award / Description / Dates
  1. Please describe your current scientific research role:
  2. Please provide a short description of yourcurrent scientific research project:
  3. Please provide a motivation of why you are applying for a Connect Africa Scholarship:
  1. What are the objectives of your trip? Please provide details of your proposed timeline.
  1. Please provide more detail on your scientific training needs and how this trip will be of benefit to you?
  1. Have you applied to any other organisation(s) for funding for this trip?

(If YES, please give details)

  1. Please list any publications that you may have or are currently working on.

In order to complete this application please submit the following supplemental documents:

  1. 3 letters of recommendation:one should be from your current mentor. If you will be visiting a different institution, you will also need to submit a letter of support from your host. All individuals should be familiar with your work.
  2. budget
  3. budget justification
  4. CV
  5. If attending a course or conference please provide details of content of the event

Statement by Applicant

I certify that the above information is correct, and that I am conversant with the conditions under which the scholarship will be awarded.If awarded the scholarship I agree to submit a 1‐2 page report on my trip and give permission for AHRI and affiliates to use trip reports and media for publicity and marketing purposes.

Date:Signature of applicant:

Statement by Supervisor

I hereby approve of the submission of this application for funding.

Date:Signature of Supervisor:

FOR OFFICIAL AHRIUSE: SCHOLARSHIP REVIEW COMMITTEE
This application is supported / YES / NO
Evaluation of applicant according to merit / Outstanding / Very Good / Good
Summary report:
Convenor SRC:
Signature: / Date:

CONNECT AFRICA SCHOLARSHIP GRADING SHEET

OBJECTIVE (is the aim realistic and of importance) Grade 1-5 (1=poor, 5= outstanding) / NEED (will the trainee really benefit and is there a potential for a long-term impact on candidate) Grade 1-5 (1=poor, 5= outstanding) / QUALITY OF APPLICANT (is the candidate suitable) Grade 1-5 (1=poor, 5= outstanding) / QUALITY/CONTENT OF PROPOSED TRIP Grade 1-5 (1=poor, 5= outstanding) / OVERALL (please add up scores
Reviewer 1.
Reviewer 2.
Reviewer 3.
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