APPLICATION FOR PhD STUDENTSHIP FUNDING
(please ensure that the guidelines for applicants have been reviewed prior to making this application)
First Supervisor Details
NAME OF SUPERVISOR:CURRENT POSITION & ADDRESS:
ADDITIONAL ATTACHMENTS: (please confirm separately attached) /
CV
AREA OF EXPERTISE WOULD BE WILLING TO PEER REVIEW APPLICATIONS ON: (Rosetrees ask the supervisors of projects that we fund to peer review on our behalf a limited number of future applications in their area of expertise):
The above is the main supervisor but if you wish please mention other supervisors integral to the project here:
Student / Clinician Details (if known)
NAME:CURRENT POSITION & ADDRESS:
BRIEF CAREER PLANS
(if known):
ADDITIONAL ATTACHMENTS: (please confirm separately attached) /
CV
PLANS TO FIND SOMEONE IF NOT YET APPOINTED:
Project Details
LAY TITLE OF PROJECT:LAY SUMMARY:
(Write a clear and concise project description including background, significance, justification of work and methodology. Please ensure sufficient detail is written with a maximum of 500 words)
ADDITIONAL ATTACHMENT: (please confirm this document required is separately attached) / A more detailed technical report for the purpose of external peer review
(to cover project background, hypothesis, plan of investigation / techniques involved):
· for the PhD Stipend round a maximum of 3 pages with a minimum font size of 11 points including a maximum of 5 references
· for the PhD Consumables Only round a maximum of 2 pages with a minimum font size of 11 points including a maximum of 5 references
SITE:
INSTITUTION:
TYPE OF PROJECT:
(please check one option) / PhD Studentship Clinical Fellowship PhD Grant MBPhD
FUNDING REQUEST:
(please check one option) / Stipend/Salary with Consumables Consumables Only
TOTAL COST OF PROJECT: / £ / NUMBER OF PEOPLE AFFECTED BY THE DISEASE IN
ROSETREES GRANT REQUESTED: / TOTAL: £ / THE UK: / WORLDWIDE:
PER ANNUM: £ FOR YR(S)
DATE OF PROJECT: / FROM: / TO:
SOURCES / AMOUNTS OF OTHER FUNDING FOR PhD (including tuition fees, stipend and consumables): / For Consumables Only Applications:
Please confirm that the stipend has already been secured
Or that the stipend is actively being sourced
Project Plans
PLEASE PROVIDE A SUMMARY OF THE PROJECT COSTS BEING APPLIED FOR WITH A BREAKDOWN BY YEAR, INCLUDING A GENERAL LIST OF CONSUMABLES EXPENDITURE *:* Any substantive deviations during the project need to be explained as these costs will be accountable in the final reporting
SOURCE OF APPLICATION:
(please check one option) / Prospective PhD Student / Clinical Fellow / MBPhD Applying
Applying on Behalf of Prospective PhD Student / Clinical Fellow / MBPhD
Other please specify
WHERE / HOW DID YOU HEAR ABOUT ROSETREES TRUST?
ARE ANY ANIMALS PLANNED TO BE USED IN THIS RESEARCH?
No Animals Being Used
Animals are Being Used
Please confirm animal use is planned: only where absolutely necessary
compliantly under appropriate legislation
with approval from Home Office / Animal Welfare / Ethical Bodies
Future Plans / Project Impact (please keep answers in this section to a maximum of 200 words)
TIMESCALE OF RESEARCH PROJECT: (a brief breakdown in simple English highlighting what is planned for each year of the project and what will be the deliverable at the end of the project)NEXT STAGES OF RESEARCH ON COMPLETION OF THIS PROJECT TO ACHIEVE PATIENT BENEFIT:
TIMESCALE FOR PATIENT BENEFIT: (what do you hope will be the patient benefits (i.e. drugs / new device / diagnostics etc) and when do you estimate these to be achieved)
ANY OTHER RELEVANT INFORMATION: (such as training in technical or specialised skills)
NAME / SIGNATURE DATE
Please email this application form and all the additional attachments mentioned throughout to before the advertised deadline for the round.
Rosetrees Trust Russell House 140 High Street Edgware Middlesex HA8 7LW Tel: 020 8951 2588
Fax: 020 8952 2424 Email: Web: www.rosetreestrust.co.uk
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