UNIVERSITY OF IBADAN, IBADAN, NIGERIA

CENTRE FOR CONTROL AND PREVENTION OF ZOONOSES

2013/2014 MASTER OF SCIENCE IN EPIZOOTIOLOGY SCHOLARSHIP APPLICATION FORM

Please complete this form and return by email to , a copy to and
Use more space than is provided if you need to.
1. Personal details
Title, first name and last name:
Institution:
Department:
Address:
Postcode:
Country:
Telephone:
Email:
2. Educational Background
(List all higher education institutions you have attended with dates, starting with the undergraduate up to graduate levels. Provide a transcript of academic records from each institution where you earned a degree; undergraduate and graduate. Applicants from Francophone West African countries are encouraged to apply, provided they are proficient in English language).
3. Date of submission of this application
4. Academic programme applied for and expected commencement date
5. Detailed plan of study
Give a scientific proposal on your intended research; indicate the area of its focus among advertised themes on surveillance of human-animal diseases in West Africa. To undertake a research, you should describe the aim of the study, the methodology you will use and the potential value of the research to the mandate of the Consortium for Control and Prevention of Zoonoses (CCPZ) in West Africa. You need to state how the research will impact development. Give a title, an introductory background, research questions or hypotheses to address, objectives and justifications for the study. (Do not exceed three pages).
6. Eligibility (confirm your eligibility by ticking the boxes as they apply to you)
a.  I am a resident of an English-speaking West African country
b.  I am a resident of a French-speaking West African country
c.  I am employed by a University in West Africa
d.  I am employed by a national/state/local Ministry of Health/Agriculture/Environment
e.  I am nominated by my agency/home institution for this Scholarship
Dean or Supervisor or Director / Name/Address:
Email: Tel.
Field of Study or Employment
Title of last research completed as a student or present job description /
Start date of training programme as student or start date of present job /
Please attach letter of support from your institution (the Dean, Supervisor or Director) / Is it attached here? Yes [ ] No [ ]
Responsibilities. Summarize your main responsibilities in your current post, in particular those that are relevant to this application.
7. List your most recent publications (up to 5). Papers in press, posters and presentations can be included.
8. Give the name and full contact details of one referee other than your current Dean/Supervisor/Director. We may contact your named referee and/or your current Dean/Supervisor/Director for a reference.
9. Funding
A scholarship will cover the cost of tuition, accommodation on campus, travel to and from home country, and conference attendance that shall be approved as appropriate. At the University of Ibadan, accommodation will be allocated by the Students Affairs Division into post-graduate students’ hostels. Research equipment and reagents shall be provided by the centre as much as possible as student support. Applications will be evaluated by the Centre, based on a set of eligibility criteria. Scholarship will be awarded on a competitive basis.
Have you applied, or do you intend to apply to any other funding sources for this graduate training?
YES/NO
If yes, to whom and for how much? Please state when you expect to know the outcome of the application(s).
10. Justification for a scholarship award
(Explain what the potential outcome(s) of your graduate training will be and how your research and team work in human-animal disease surveillance will benefit you, your country and others. Discuss your career plans. What are your long term goals? What involvement in service, teaching, research and practice do you anticipate? What further training will you seek? )

APPLICANT’S DECLARATION

I declare that the details on this form are correct to the best of my knowledge. If I am awarded a scholarship, I will use it under the terms and conditions attached to it by the CCPZ (see below) and only for the purposes stated in this application form. In making this application, I am consenting to CCPZ holding my personal details and understand that they will only be used for the purpose of evaluating this application. I accept that CCPZ may disclose this application form to any third parties that it considers necessary to reach a decision on the application. If I am awarded funds for this training by any other party, I will inform CCPZ within two weeks of offer or receipt of these funds and accept that the contribution offered by CCPZ may be modified accordingly, or withdrawn altogether.

NAME:

SIGNATURE:

DATE:

UNIVERSITY OF IBADAN CCPZ SCHOLARSHIP AWARD TERMS AND CONDITIONS

Scholarship awards are offered under the following terms and conditions:
1.  That the applicant has an admission letter to the M.Sc. Epizootiology programme of the University of Ibadan in line with the mandate of CCPZ.
2.  That the graduate programme is undertaken as outlined in the application, and for the purpose of contributing to capacity building in control and prevention of endemic, emerging and neglected zoonoses in West Africa.
3.  The scholarship is a personal award made to the named applicant and cannot be transferred to another person or to an institution/organization.

Supported by the John D. and Catherine T. MacArthur Foundation