CAPTIVE CARE GRANT - APPLICATION FORM
Please ensure you have read the Guidance Notes before completing this form and upload it via the PSGB Captive Care grant submission system (http:// http://www.psgb.org/captivecare_submission.php).
Enquiries to Dr Paul Honess, E-mail: .
1. PROPOSED PROJECT TITLE:
2. COUNTRY: 3. PROJECT DATES:
4. PRIMATE SPECIES INVOLVED (including scientific names):
5. DETAILS OF APPLICANT:
Name -
Contact Address(es) -
Telephone -
Fax -
E-mail -
Current occupation -
Relevant experience and/or qualifications (please paste a brief C.V. below) -
PASTE YOUR BRIEF CV HERE
Are you a member of PSGB? YES / NO
If NO, you must join the Society first. Please see: http://www.psgb.org/membership.php
6. DETAILS OF PROJECT:
Please include on this form a project proposal of not more than 1,200 words. This should include:
1) An abstract (max 200 words; abstracts of successful applications may be published online)
2) A proposal which MUST include the following sections: Aims, Methods, Project timetable, Expected outcomes, Direct benefits for primate welfare (you should make it clear how the outcome of your project will benefit primate welfare);
3) Name, nationality and affiliation of any others directly involved in the proposed project;
4) A budget breakdown, with major costs itemised and justified;
5) The amount requested from PSGB;
6) Support from other sources (please specify the amount, and whether received or applications are pending).
PASTE YOUR PROPOSAL HERE
7. CONFIDENTIAL REFERENCES - You should send the "Confidential Reference" form, and a copy of your project proposal, to two referees, who are able to comment on your ability to complete the proposed project (the form is available at http://www.psgb.org/captivecare_submission.php). Please ensure that they each submit their confidential reference by email to the Convenor of the Captive Care Working Party () BEFORE the grant deadline. Please also provide their names and contact details (including email address), below:
Referee 1 Referee 2
Name: Name:
Address: Address:
Email: Email:
8. UNDERTAKING BY HOST ORGANISATION
You should request a statement from your host establishment stating that it is willing for you to conduct the work described in the project proposal. This statement should be emailed to the Convenor () BEFORE the grant deadline.
Name and email address of person providing statement:
9. METHOD OF PAYMENT - If your application is successful, how can funds best be transferred to you?
10. STATEMENT BY APPLICANT (Please tick the boxes to confirm)
I have included in this form:
Ø A brief C.V. □
Ø A project proposal (max. 1200 words) □
Ø Names and contact details of two referees, whom I have asked to send their
references to the Convenor, in advance of the application deadline □
Ø Name and email of person providing the institutional consent statement □
I agree that by submitting this application I confirm that information given in this form/application process is to the best of my knowledge true and accurate. Submission also confirms that if awarded, I undertake to use PSGB Captive Care funds solely for the purposes for which they are awarded, and I agree to abide by all obligations of grantees under point 2 of the Guidance Notes.
Signed ...... Date ......
How did you hear about the PSGB Captive Care Grants? ……………………………………………………………………………………………………………………………………………
********** Next deadline: 28th February next year **********
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