APPLICATION FOR A TRAVEL AWARD
Registered Charity 516898.
Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: 7 Grove Park Court, Harrogate, HG14DP.
1. Before completing this form please read Information for Applicants, Award Conditions and Policies for Awards found at http://yorkshirecancerresearch.org.uk/for-researchers/2015-funding-round/.
2. PLEASE ENSURE ALL SECTIONS ARE COMPLETED.
3. Email a copy in MS Word to – remember to save the form with a meaningful file name.
4. The Head of Department, Finance Department and Applicant must sign the form (electronic signatures are accepted.)
5. If you have not already done so, please email the abstract to to obtain the charity’s approval to publish.
Applicant(s) surname(s) / Forename(s) / Title / Email address / End date of current funding.State contract end date and FTE (%)
Full postal address of applicant / Telephone number
Present appointment
Present employer
Current YCR award held/on which employed (please include YCR reference and tenure of award). / Total amount requested from YCR (£)
Travel award deadline
(1 Feb, 1 May, 1 Aug, 1 Nov)
TERMS AND CONDTIONS
ACCEPTANCE OF CONDITIONS AND POLICIES FOR AWARDS
· I/We have read the charity’s current Award Conditions and Policies for Awards and if my/our application is successful I/we agree to abide by them.
SIGNATURE OF PRINCIPAL APPLICANT
(scanned signatures are acceptable here) / DATE
This application should be submitted by/through (i) the Principal Applicant’s Line Manager and/or Head of Department and (ii) the officer who will be responsible for administering any award that may be awarded (e.g. Head of Finance, Finance Officer, Bursar, Registrar, Secretary). Each should sign the following declaration:
· I confirm that I have read this application and that, if granted, the work will be accommodated and administered in the Organisation/ Department in accordance with the Award Conditions.
HEAD OF DEPARTMENT
Title / Name
Job Title
Organisation
Postal Address
Address Line 1
Address Line 2
Town/City
Postcode
Phone Number / Email Address
Signature
(scanned signatures are acceptable here) / Date
ADMINISTRATIVE AUTHORITY
Title / Name
Job Title
Organisation
Postal Address
Address Line 1
Address Line 2
Town/City
Postcode
Phone Number / Email Address
Signature
(scanned signatures are acceptable here) / Date
DETAILS OF TRAVEL
Conference/visit proposed. Please include title and location.Date of proposed Travel / Proposed duration
Brief statement of precise purpose of visit.
Are you an invited participant?
(If so, give details of support offered by organisers)
Are you presenting a paper/poster, etc?
Please provide the title, author list and abstract (or draft version)
Please indicate whether you have reviewed condition 6.1 of the charity’s Conditions of Award available here:
Award Conditions for 2015 / Yes/No
Has the data been publicly disclosed previously?
Where the data you are submitting is similar or related to an earlier disclosure you have made, please supply the earlier disclosure reference (0XXXD or XXXX-DRX) and also indicate how the new disclosure differs from the previous disclosure.
If you are a University of Leeds researcher, please remember to copy disclosure requests to the Stratified Medicine Hub () at the same time as you submit this abstract form.
EXPENSES
Registration fee (if applicable)Travel within UK (to point of embarkation if overseas visit)
From:
To:
Lowest fare:
Mode of transport:
Overseas Travel
From:
To:
Dates of travel:
Lowest return air fare:
Flight numbers:
Travel Agent including contact details:
Accommodation
Subsistence (per day)
Hotel (per day)
Total sum requested £
(to nearest £)
Other sources of assistance
Have you applied for travel funds from your own institution?Please give details of assistance which is assured from other sources and/or applications which have been made, or will be made, giving expected date of result, where known.
(i) Assistance assured (applicant’s personal contribution should be identified separately here)
(ii) Pending or proposed application (results should be communicated to YCR when known)