Prize: Up to £5,000

The RCOG is proud to support the organising committee of the 13th Annual World Congress of Endometriosis who, through a generous donation, have established the Endometriosis Millennium Fund.

Available to RCOG Members and Trainees working in the British Isles, this funding has been donated in order to stimulate and encourage research (clinical or laboratory based) in the field of endometriosis. Clinicians are encouraged, with the use of funds, to acquire extra clinical skills in order to more efficiently manage patients with the disease.

CONDITIONS

•If the application is for travel funding, travel must take place within 12 months of the award being made in October 2017

•The award may only be used for the purpose outlined in your original application

•A detailed report (maximum 1000 words), including pictures if necessary, must be submitted to the RCOG Awards Administrator within eight weeks after the elective

TO APPLY:

Please send the following documents to the Awards Administrator by email (E:) by midnight on Wednesday, 31 May 2017

  • Completed application form
  • Two references from supervisors or senior colleagues (see Section 4)
  • A short CV (maximum of four A4 pages) including university details
  • Approval from the institute to be visited (if applicable) (Section 2, Part 1)
  • Confirmation of available laboratory space (if applicable) (Section 2, Part 2)

Applications received after the closing date will not be accepted.

SECTION 1

PERSONAL DETAILS

Name of applicant:
Membership/Trainee number:
Date of RCOG Membership or intended date of sitting exam (if applicable):
Current appointment (Grade and Institution):
Work Address:
Correspondence Address (if different from above):
Telephone number:
Email address:
Date of birth:

SECTION 2

DETAILS OF THE PROJECT

Title of project:
Proposed duration:
Proposed starting date:
Abstract of research (Attach separate sheet if required):
Have you enclosed confirmation of the availability of laboratory space or access to surgical training at the host institution? (please tick) / YES NO
Please list details of any other financial assistance being requested and/or obtained for the visit including other RCOG Awards and Prizes:

SECTION 3

Please describe how the award will be spent

SECTION 4

REFERENCE

You must provide TWO references from two supervisors or senior colleagues in active clinical practice with this application.

REFERENCE 1

Name:
Role:
Email address:
Telephone:
Relationship to applicant:

REFERENCE 2

Name:
Role:
Email address:
Telephone:
Relationship to applicant:

SECTION 5

How did you hear about this award? Please tick all that apply.

Word of mouth
RCOG website
RCOG email
RCOG magazine
University/Hospital communication
Other

I understand that the grant may only be used for the purpose outlined in the original application and I confirm a written report will be submitted to the RCOG within 8 weeks after travel/completion of the project and that the grant will be acknowledged in any related publications.

APPLICANT SIGNATURE
DATE

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