/ Distinguished Visiting Fellowship Scheme

Application Form

Please type or complete in black ink using block capitals. The length of this form is restricted to two pages.

1. Nominating Host Institution

Name and Address
Department
Contact
Position
Telephone / Fax
E-mail
Royal Academy of Engineeringand Other Awards Held (in the last 2 yearswith dates)

2. Nominee

(Please attach a Curriculum Vitae with evidence of eminence including, for example, information on prizes/awards, national/international committee membership, invited lectures etc)

Name and Work AddressOverseas (including academic title, institution name and department)
Country / Date of Birth1 / Nationality2
Current Position and Date of Appointment
Field of Specialisation
Subject area (e.g. Mechanical engineering, electrical and electronic engineering etc)
Telephone / Fax
E-mail
Length and Type of Past Links / Collaboration with Host Organisation and/or the UK, if any
With details of the value to be added –especially beyond the Host- because of Royal Academy of Engineering funding for the visit

1, 2required for monitoring purposes only

1

3. Purpose of Visit

Please indicate the main activities to be undertaken and the expected outcomes, including how the host institution intends to maximise the benefits gained from the Fellowship.

3.1 General purpose of the visit

3.2The main activities to be undertaken

(Please attach a programme of activities)

3.3 The expected outcomes

For the Host
For the UK
For the Visiting Fellow and overseas country

3.4 Intended Ways of Maximising the Benefits from the Fellowship

(e.g. planned dissemination activities and future links and collaboration)

4. Funding requested (To be evidenced by attached information)

Air fare costs(please indicate whether the applicant will be accompanied by a partner/dependants, Yes No )
£
Costs of accommodation(please attach details)£
Daily allowance (a maximum of £100 per day is stipulated towards child/dependant care, subsistence etc)£
NOTE:
Funds requested must be justified at application stage. / TOTAL COSTS£

Timing of visitPlease return the completed form to:

Please indicate the start and completion dates of the nominee’s visit to the UK(note that visits must be completed within six months of the date of notification of the award). / Dr Imren Markes,
Manager- Industrial Secondments
and Visiting Fellowships,
The Royal Academy of Engineering,
3 Carlton House Terrace,
London,
SW1Y 3DG
Tel: 020 7766 0615 Fax: 020 7389 7514
Email:
Commencing date
Completion date

1