AUSTRALIAN RESEARCH FOUNDATION/ AUSTRALIAN MUSEUM RESEARCH INSTITUTE

LEO FLEISCHMANN VISITING FELLOWSHIP

APPLICATION FORM 2016

NOTE:

To complete the application form:

1.Open and fill in the electronic Word file

2.Save the completed form and attach it to an email addressed to:

3.Print out the completed form, obtain relevant signatures and post it to the address below along with other required documentation.

One original hardcopy and one electronic copy should be submitted by 5pm Friday 15 April 2016.

  1. Title and Name of Applicant

  1. Applicant’s Contact Details

Postal address:

Email address:

Phone number:

Institution:

  1. Project title

  1. Period for which Fellowship is sought
(approximate dates and total length, including how much time will be spent at the Australian Museum)
  1. Location and duration of any field work or visits to other institutions during period of Fellowship

  1. Does the Fellow intend to have an additional person(s) (eg spouse, student, etc) involved in the research project or in other areas of the Museum during their stay?
(if yes, give details)
  1. Proposed Research

Contribution to AMRI Objectives (double left click on box to “check or uncheck”)

Please refer to the Australian MuseumScience Strategy 2014 – 2017. Applications should address AMRI research priorities.

AMRI Research Priority / Explain how the priority will be addressed
  1. Use of our research and collections expertise to understand and ameliorate the environmental impacts of climate change on biodiversity

  1. Contribute to the understanding and management of biosecurity threats

  1. Discover and understand biodiversity to inform effective animal conservation

  1. Apply wildlife genomics to solve key problems

  1. Generate knowledge to maximize benefits from Australia’s geological and biological resources

  1. Foster understanding and appreciation of cultural differences for a more socially inclusive society through our anthropological and archaeological research

Objectives, Methods and Outcomes of Proposed Research

Maximum 3 pages (not including references) Including statement of the research problem; how it will be carried out.; what progress has already been made; how long the project will last (including a schedule); what outcomes are expected, including publications.

Budget(grant funded by the Australian Museum Foundation)

An itemised budget for the way in which you propose to use the requested money in your researchwith brief justification

Item / Cost
Total Cost / $
  1. Equipment or services required from Australian Museum for Fellow
(indicate if equipment can be supplied by you if not available)
Equipment
Other
(eg laboratory space, office space, access to equipment)
  1. Names and contact details of two referees from outside the Australian Museum

  1. Other documents that should be submitted with your application

  • Statement on letterhead from the applicant’s employer certifying that his or her salary or stipend and associated expenses will be paid by that institution during the tenure of the fellowship
  • Statement of support from Australian Museum Pacific Collection Manager Dion Peita
  • Curriculum vitae (including a list of publications)

Applicant to complete

Signature of Fellowship Nominee:

______Date:

Signature of Head or delegated authority of Applicant’s institution (if appropriate):

“I certify that this institution supports this project.”

______Date:

Position:

One (1) original hardcopy and one (1) electronic copy of the application should be sent to:

Alexandra Nuttall

AMRI & External Partnerships Support, Science & Learning, Australian Museum Research Institute

Australian Museum

6 College Street SYDNEY, NSW 2010 Australia

Phone: (+612) 9320 6248

Fax: (+612) 9320 6015

Email:

The closing date for applicationsis5pm Friday 15 April 2016.

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