PRINCIPAL APPLICANT 2 (Physics / Chemistry)

Tags

PRINCIPAL APPLICANT 2 (Physics / Chemistry)

ROSETREES TRUST
INTERDISCIPLINARY PRIZE 2018
University of Bristol internal application form

Please complete this form to the best of your ability and to an extent that would enable the internal University of Bristol panel to assess the alignment of your proposal with the prize criteria.

Please email completed form (and the additional attachments such as CV) to Nina Couzin by Thursday 10am 7 December 2017

TITLE OF PROJECT:

PRINICPAL APPLICANT 1 (Medicine)

NAME:
CURRENT POSITION:
ADDRESS and E-MAIL:
ADDITIONAL ATTACHMENTS: (please confirm these documents required are separately attached) / CV (ideally no more than 2 pages with a photo if possible)
5 highest impact / most relevant publications

PRINCIPAL APPLICANT 2 (Physics / Chemistry)

NAME:
CURRENT POSITION:
ADDRESS and E-MAIL:
ADDITIONAL ATTACHMENTS: (please confirm these documents required are separately attached) / CV (ideally no more than 2 pages)
5 highest impact / most relevant publications

CO-APPLICANTS (If Applicable from Either Discipline)

NAME(S):
CURRENT POSITION(S):
ADDRESS and E-MAIL(S):
ADDITIONAL ATTACHMENTS: (please confirm these documents required are separately attached for each co-applicant listed) / CV (ideally no more than 2 pages)
5 highest impact / most relevant publications

PROJECT DETAILS

SUMMARY:Please providea clear and concise project description including background, significance, translational impact, justification of work and methodology (Maximum of 500 words).
ROSETREES GRANT REQUESTED: / TOTAL: £ / NUMBER OF PEOPLE AFFECTED BY THE DISEASE IN
ROSETREES GRANT REQUESTED: / PER ANNUM: £ FOR YR(S) / THEUK: / WORLDWIDE:
DATE OF PROJECT: / FROM: / TO:

TECHNICAL REPORT

Please provide a detailed technical report including background, aims & objectives, experimental plan and milestones (Max. 5 pages including references). You can either include the report in the space below, or alternatively if you wish to attach a separate document please tick this box to confirm this has been included in your submission

COST BREAKDOWN

Please provide a summary of the project costs being applied for with a breakdown by year:
Please email this application form and the additional attachments to Nina Couzin by Thursday 10am 7 December 2017

Rosetrees Trust Russell House 140 High Street Edgware Middlesex HA8 7LW Tel: 020 89512588

Fax: 020 8952 2424 Email: Web:

Trustees: Richard Ross (Chairman) Clive Winkler Lee Mesnick Sam Howard (Chief Executive)

VAT Registration Number: 185 1156 09

Registered with the Charity Commissions as The Teresa Rosenbaum Golden Charitable Trust Charity number 298582