Part 2. Your host institution - European Society of Cardiology

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Application for (Laboratory) Exchange Grant Forms

Part 1. Applicant details

Name

Current position

Department

Current institution and address

Email address

Head of department

If you are a student:

Programme of study

Date started

Part 2. Your host institution

Host institution and address

Department

Proposed supervisor at host institution

Supervisor email address

Proposed start date

Proposed ending date

Are any elements of the proposed project already funded from another source? (please provide details)

12 months

1

Part 3. Your project

Outline of project - background, hypotheses, aims, methods, expected results, references, dissemination & impact

(up to 3 pages in size 12 font)

Timeline of objectives, include an overview of when key milestones of the project will be met

(1 page)

PART 4. Your CV

Part 5. Host Institution Statement of Support

To be completed by the proposed supervisor of the host institution

I confirm that I have approved the project described in this application

I confirm that I have read and understood the rules of this grant application

I confirm that the duration of my contract covers the time of the proposed project

Supervisor Name

Title of Current Post

Supervisor’s Institution

Statement of Support

– up to 1 page

Please provide details of:

1.

Relationship with the applicant

2.

Recommendation of the applicant for this award

3.

Training that you plan to provide for the applicant

2

Please attach also a brief CV and relevant publications of the previous 5 years of the Supervisor in the Host Institution.

3

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