Pecreaward Application Form

PECREAWARD APPLICATION FORM

For applications to the SRPe Postgraduate and Early Career Researcher Exchange (PECRE) fund, please complete the application form below and submit it, along with supporting documents, to Susan Hamilton, SRPE Project Manager, at .

The submission deadline is 5pm on Wednesday 31st January 2018.

Part 1 – Applicant Details

Institution Name
Applicant Name
Position
School/Department
Contact Address
Telephone
Email

Part 2 – Details of Host(s)

Please use the table below to provide details of the individual(s) and organisation(s) that will host your exchange. You will also need to provide a signed letter (as pdf) from each host with your application confirming that they are prepared to accept you to undertake the work proposed and for the stated duration. Failure to provide this information with your application will render it ineligible.

Institution / Organisation Name
Exchange Host Full Name
Position
School/Department
Contact Address
Telephone
Email

For any additional hosts please add separate boxes.

Part 3 – Details of the Proposed PECRE Activity

Activity Start Date
Activity End Date
PECRE Activity Title
(SRPe will use this title for external communications & reporting)
Brief description of the PECRE Activity
(Max 200 words.)
(Attach any relevant documents as Appendices)
Brief Description of Planned Outputs / Outcomes
(Max 200 words)
Which SRPe Strategic Theme(s) does the PECRE Activity align with?
How will you and your host organisation benefit from the PECRE Activity?
(Max 200 words)
What further steps, if any, do you anticipate taking following on from the PECRE Activity?
(Max 200 words)
Any additional comments to support your application?
(Max 100 words)
In the box below, please include anabstract describing the proposed PECRE activity. In the event that the application is successful, the abstract may be published on the SRPe website and used in other SRPe publicity material.
(Max 300 words)

Part 4 – Criteria for Selection

You should provide details of the following in the box below:

Evidence of your ability such as: outputs/references; leadership; innovation.
Likely benefits to the research to you such as: new skills; techniques likely to be acquired, as a result of the exchange.
Likely benefits to your longer terms career as a result of the exchange.
Evidence of wider benefits to the SRPe as a consequence of the exchange
Prospects of sustained collaboration as a result of the exchange.

(Max 300 words)

Part 5 – Costs

Please provide a detailed breakdown of estimated costs below.This should include the costs (in GBP) of work/activity which will be funded by (a) SRPe, (b) bodies other than SRPe (e.g. the applicant’s institution), (c) ‘in kind’ contributions as a value, as appropriate.

Funding Body / CostContribution / Description
(a) SRPe / £
(b) Other than SRPe / £
(c) ‘In Kind’ / £
Total Cost: / £

Please insert additional lines as required.

Total Cost to SRPe / £

Part 6 –Data Protection

SRPe will use information provided on the application form, for the purpose of processing the application to assess its suitability for support. If the application is successful, SRPe will use the information for administration and management purposes, including carrying out appropriate checks, audits and marketing.

Part 7–Applicant Signature

Please ensure the application form is signed by an authorised institutional approver before submission. Applications submitted without institutional sign off will not be eligible for funding.

Institutional Approval
Institution Name
Approver Name
Job Title
Signature
Date
Applicant Signature
Date

PEER & PECRE Equality and Diversity Monitoring Form

The Scottish Research Partnership in Engineering is committed to ensuring that applicants and employees are not subject to direct or indirect discrimination based on protected characteristics of age; disability; gender reassignment; marriage and civil partnership; pregnancy and maternity; race; religion or belief; gender; and sexual orientation; or any other irrelevant factor.

We would be grateful if you would complete this form and return it with your application. The information will not be used as part of the selection process itself and will be held in compliance with The Data Protection Act 1998. The information contained in this form will be used solely for statistical purposes. Your co‐operation in completing and returning this form is appreciated.

Basic details / Response
Name
Institution
What is your age? / Response
16-24
25-34
35-44
45-54
55-64
65+
What is your gender? / Response
Male
Female
Other
Prefer not to say
Is your gender identity the same as the gender you were originally assigned at birth? / Response
Yes
No
If ‘No’, specify if you wish
Prefer not to say
Ethnic Origin: The options reflect the census ethnicity classifications used throughout the UK and allow comparative statistics to be derived both within and out with the sector. Tick the most appropriate box to indicate your ethnic origin.
White – British / White Scottish / White – Irish
Other White background / Asian or Asian British – Indian / Asian or Asian British – Bangladeshi
Asian or Asian British – Pakistani / Chinese / Other Asian background
Black or Black British – African / Black or Black British – Caribbean / Other Black background
Mixed – White and Black African / Mixed – White and Asian / Mixed–White and Black Caribbean
Other Mixed background / Not known / Prefer not to say
Other Not Listed Above
What religion, belief or faith do you belong to? / Response
None
Christian: Church of Scotland
Christian: Roman Catholic
Christian: Other Christian (please specify)
Muslim
Buddhist
Sikh
Jewish
Hindu
Humanist
Another religion or belief (please specify)
Prefer not to say
How would you describe your sexual orientation? / Response
Bisexual
Gay man
Gay woman / Lesbian
Heterosexual / straight
Not sure
Other (please specify)
Prefer not to say
What is your legal marital or same sex partnership status? / Response
Single
Married / Civil Partnership
Separated
Divorced / dissolved Civil Partnership
Co-habiting / in a relationship
Widowed / surviving partner from Civil Partnership
Prefer not to say
Parental Requirements Please select if you are:
On additional paternity leave / On adoption leave / On maternity leave
Pregnant / Prefer not to say / Not applicable
Do you have a disability? / Response
I have a disability
I have no disability
Prefer not to say

Thank you for taking the time to complete this form.