Centre for Neuroscience
Researching the nervous system in health and disease

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Scientific - Exchange FUNDING Application

Limited funds (maximum of $2,500 per application) are available from the Centre for Neuroscience (CNS),to promote scientific exchange visits, between Flinders-based CNS researchers and external researchers / organisations.

These funds are intended to assist CNS neuroscientistsin one or more of the following:

▪developing new research teams and collaborative projects,

▪building on past successes in project grant funding,

▪investigating new techniques and alternative practices,

▪increasing our competitiveness for future grant applications.

Please complete this form, attach the relevant documentation, sign the declaration and forward the application to the CNS Secretary. There is no closing deadline for applications, they can be submitted at any time during the year and will be considered by the sitting CNS Executive Committee, at the time.

*Members can only submit one (1) application per year. Only Student Members can apply for conference associated expenses. Full Members cannot apply for conference support.

Beginning in 2017, PhD Students can only apply for support for one (1) international conference during their candidature.

Please note that providing a 10min talk (as part of a group presentation) on the visit AND a powerpoint slide covering the highlights, have just been added to the obligations imposed on successful applications. A full NeuroSeminar can be substituted for the 10min talk, if the visitor so wishes. If you are unable to comply with these obligations, please do not apply for scientific-exchange funding.

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Applicant's Name
Applicant's Email Address
Type of Application
Please select only one option per application / Visit by CNS researcher
Visit by external researcher (please complete fields below)
Name:
Email address:
Organisation:
Visit Details / Start Date / End Date
Reason for visit
How will this visit benefit the CNS?
Collaborative projects, grant funding, new techniques, etc.
Will this visit result in a Seminar OR10min presentation to the CNS? (one must be chosen)
Date of Seminar or 10min presentation
(check date/time availability with CNS Secretary)
Following the visit, do you agree to supply a powerpoint slide of the highlights (including images) for the CNS AGM and Annual Report?
Date by which the powerpoint slide will be provided
Funding Request Details
Type and amount of each expense included in funding request
Please leave blank, the expense lines not relevant
to this application. / Airfares / $
Accommodation / $
(Student only option) Conference Registration / $
Other: / $
Other: / $
Other: / $
TOTAL AMOUNT BEING REQUESTED
Maximum of $2,500 per application / $
Please nominate four (4) current CNS Members to support this application
Each of the CNS Members listed below will be emailed and their responses sent to the
CNS Executive Committee, along with this application,for their consideration.
Member 1 / Name:
Email:
Member 2 / Name:
Email:
Member 3 / Name:
Email:
Member 4 / Name:
Email:
Applicant's Checklist and Declaration
Checklist of attachments
Itinerary of visit
Visitor's CV
Quotes or receipts for airfares (if applicable)
Quotes or receipts for accommodation (if applicable)
Quotes or receipts for conference registration (if applicable)
Quotes or receipts for all other expenses claimed (if applicable)
Declaration
▪I am a current Full or Student Member of the Centre for Neuroscience
▪I have not already been awarded CNS Scientific-Exchange Funding money this year
▪No other source of funding has been applied for, relating to any of the expenses claimed in this application
▪Where funding is for an external visitor to Flinders, no money requested will be used to pay for meals for Flinders staff or students (including applicant)
▪No funding is being requested for any personal (non-research related) component of the visit
▪No money for alcohol has been included in this application
▪I acknowledge that my application does not guarantee fundingand that only partial funding may be granted
▪Upon cancellation of the visit, for any reason, a full and immediate refund of monies will be given to the CNS
▪If successful, I agree to provide the required seminar/talk and powerpoint slide, in a timely manner following the visit's conclusion.
Signature of Applicant
Electronic signature or email confirmation, accepted in lieu / Date

Please complete this form and deliver to the CNS Secretary, via one of the methods below.

Electronically:

Printed:Anatomy & Histology Office (room 6E121), Flinders Medical Centre

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Enquiries: Phone: +61 8 8204 5271