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THE CHRISTOPHER
WELCHSCHOLARSHIP
2010
1.Name of candidate:
2.Address:
(a)current:
(b)for correspondence in March and April 2010 (if different):
(c)e-mail address:
3.Name of Nominating Department:
4.Name of Supervisor:
Post:
Address:
Telephone Number:
5.Period for which support is sought:
6.Proposed starting date:
Signature of applicantDate
TO BE SIGNED BY THE SUPERVISOR
8.I have read the guidance notes for the Christopher Welch Scholarship and, if this application is successful, I agree to abide by the terms outlined in them. I shall be actively involved in the day-to-day control of the project.
Signature of SupervisorDate
continued overleaf..
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TO BE SIGNED BY THE HEAD OF DEPARTMENT
9.I confirm that I have read and support this application. I confirm that this student has been accepted by the department as a P.R.S./M.Sc./D.Phil. student and that I agree to this research being carried out in my department, and that all necessary licences and approval have been obtained or are being sought. I confirm that any research expenses, over and above what would normally be met by the department, are itemised below together with an indication of how it is proposed to pay for them.
I wish the candidate to be considered for the Christopher Welch Scholarship.
Signature of head of department:Date:
Statement regarding additional research expenses.£
Consumables
Equipment
Travel
Other
──────
TOTAL COSTS
──────
Departmental Contribution
══════
Candidates are asked to supply all necessary information in the spaces provided on this form. Please DO NOT SUBMIT SUPPLEMENTARY MATERIAL other than references.
Candidates are asked to send the application to the Director of Graduate Studies in the Department in which they hope to work by FRIDAY, 8 JANUARY 2010 if the department is within the Medical Sciences Division and by FRIDAY, 22 JANUARY 2010 if the department is within MPLS Division.
If the Department wishes to nominate the candidate for consideration by the CW Board of Management, this form should be completed, and countersigned by the Head of Department.
Clinical Departments in the Medical Sciences Division should then send 6 copies of this form, along with 6 copies of the candidate’s University application to the Graduate Studies Officer, Medical Sciences Office, Level 3, JR Hospital to arrive before12pm on Tuesday 16 February 2010.
Pathology, Pharmacology, Experimental Psychology, DPAG, Biochemistry, Plant Sciences and Zoology should then send 6 copies of this form, along with 6 copies of the candidate’s University application to the Graduate Studies Officer, Medical Sciences Office, Level 3, JR Hospital to arrive before 12pm onWednesday 3 March 2010.
Interviews may be held.Candidates should provide telephone numbers and e-mail addresses where they can be reached during March and April 2010.
CHRISTOPHER WELCH SCHOLARSHIP
10.Surname[STUDENT]
11.Forenames
[STUDENT]
12.Date and place of birth
[STUDENT]
13.Institution at which a final year student, or from which you have graduated
[STUDENT]
14.Topic of D.Phil. project
[STUDENT/DEPARTMENT]
15.Number of D.Phil. scholars working under the supervisor named in the application:
[DEPARTMENT] / A(a)in their first year
(b)in their second year
(c)in their third year
(d)in their fourth or subsequent year
BNumber of completed students
16.Outline briefly the future you would hope to pursue
[STUDENT]
17.What other studentships have you sought or intend to seek (Please distinguish between applications which are pending and those which are already successful)
[STUDENT]
18.Recommendation of the supervisor (this should state why and how this student has been selected).
[DEPARTMENT]
19.Please summarise your research experience to date. Also - candidates may be invited for interview - please give the title and an abstract (up to 200 words) of the presentation you would give if you were invited for interview. [STUDENT]
20.Please attach references from (i) an undergraduate tutor with whom the candidate has done some research and (ii) a head of department or tutor who can comment on the candidate’s academic record.
[DEPARTMENT]
CHRISTOPHER WELCH SCHOLARSHIP
21.Summarise the proposed research project and state the programme of training that will be provided for the candidate.[DEPARTMENT]
22.Will the project involve the use of animals, GMOs, or human subjects? If so, has the appropriate licence or ethical approval been obtained? Give the Home Office Reference and the date of issue.
[DEPARTMENT]
CHRISTOPHER WELCH SCHOLARSHIP
CURRICULUM VITAE OF STUDENT
To be completed by the Student
1.SURNAME:DATE OF BIRTH:
FORENAMES:NATIONALITY:
2.SCHOOL LEAVING QUALIFICATIONS, eg Advanced Levels, Baccalaureate etc
(with subject, grade and date)
3.DEGREE (subject, university, dates of attendance and class of degree if already graduated)
4.PRIZES
5.COURSES TAKEN
6.Summary of research projects undertaken
7.Any other information you think may be relevant