Pancreatic Cancer Action

PhD Scholarship Grant

STUDENT APPLICATION FORM 2017/18

Surname/Family Name (as in passport) / Enter text
First Name (s) (as in passport) / Enter text
Sex / Male Female
Nationality / Enter text
Do you need a student visa to study in the UK? / Yes No
Date of birth / Click here to enter a date.
Country of birth / Enter text
Country of ordinary residence / Enter text
Home Address
Address 1 / Click here to enter text.
Address 2 / Click here to enter text.
City / Click here to enter text.
County / Click here to enter text.
Postcode / Click here to enter text.
Country / Click here to enter text.
Telephone / Click here to enter text.
Email / Click here to enter text.
Correspondence address (if different from above)
Address 1 / Click here to enter text.
Address 2 / Click here to enter text.
City / Click here to enter text.
County / Click here to enter text.
Postcode / Click here to enter text.
Country / Click here to enter text.
Telephone / Click here to enter text.
Email / Click here to enter text.
What is the proposed title of your PhD?
Max 50 words
Scientific Abstract (max 250 words)
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How will this project improve/impact on early diagnosis of pancreatic cancer?
Max 120 words
Please outline how you developed your ideas for this project
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Name of proposed supervisor and Institution
Full Name / Click here to enter text.
Position & Title / Click here to enter text.
Organisation / Click here to enter text.
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Mailing address / Click here to enter text.
Telephone / Click here to enter text.
Email address / Click here to enter text.
Period of support
Proposed Start Date / Proposed Completion Date / Total No. of Months
Click here to enter a date. / Click here to enter a date. / Click here to enter text.
Education – Qualifications already obtained
Name of College/University
/Awarding Body (state country if outside the UK / Start Date / End Date / Qualification
(e.g. BA, BSc) / Class/
Grade / Degree title
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Education – Qualifications currently being taken
Name of College/University
/Awarding Body (state country if outside the UK / Start Date / End Date / Qualification
(e.g. BA, BSc) / Expected Class/
Grade / Degree title: subjects studied and grades achieved so far
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Is English your first language? / Yes No
IF no to above, have you?
Taken an English test in the last two years? / Yes No
Been educated at degree level in English? / Yes No
Employment – list your employment to date below or include a copy of your CV.
Name and Address of Employer (state country if outside the UK / Start Date / End Date / Position held and main duties
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Supplementary supporting statement
Describe your academic interests and reasons for applying. We are particularly interested in what your motivation is for becoming a Pancreatic Cancer Action PhD Scholarship Grant recipient.
Also, please detail your career objectives and any non-academic achievements as well as any publications. Outline any other relevant experience including attendance at specialist workshops or short courses. You may attach your research proposal if you have one.
Enter text here
Applicant’s declaration
I confirm that, to the best of my knowledge, the information on this application is accurate and complete.
(Please note, Pancreatic Cancer Action reserves the right to terminate the PhD Scholarship Grant should it be discovered that you have made a false statement or omitted significant information to either Pancreatic Cancer Action or to the Institution to which the Award will be granted.
Name / Click here to enter text.
Signature
Date / Click here to enter a date.

Completed applications should be emailed to and a printed copy posted to:

Pancreatic Cancer Action

PHD Scholarship Grant Applications

9, Oakhanger Farm Business Park

Oakhanger

Hampshire

GU35 9JA

Pancreatic Cancer Action PhD Scholarship Award STUDENT Application Form 2017/18