Stephen Holgate PhD Studentship Application Form Charity Reg. No. 1129698 www.aaircharity.org In recognition of Professor Stephen Holgate’s long standing contribution to the AAIR Charity we invite applications for 50% funding of a PhD studentship for studies of asthma and allergic diseases. The AAIR Charity will only consider applications that fall within the objective and policies of the Charity. AAIR will fund research into asthma, allergy and respiratory diseases primarily within the Faculty of Medicine, University of Southampton. The AAIR charity will support 50% of the studentship which comprises student stipend, tuition fees and consumables. The remaining 50% of the PhD studentship must be obtained from another funding source. This award is conditional upon the successful outcome of efforts to obtain the remaining 50% of the funding support. Please complete the following form in Arial Font 10 and attach a brief CV for the principle supervisor. (1) Details of Proposed Supervisor (s) Principle Supervisor: Name (last name, first name, title) Contact Address Current Position: Since: Email: Telephone: Title and name of co-supervisor(s) (if any) Email: (2) Details of Current Research Proposal for Studentship Title of Proposal: Duration of Project (months) Total costs applied for Start Date: End Date: 1 (3) Scientific Summary of Research proposal for Studentship (max 250wds) (4) Lay Summary of Research Proposal for Studentship (max 250wds). Please include a brief lay summary to explain the research and how it will impact patients. If the project is funded by AAIR then the lay summary will be included in the AAIR charity newsletter Lay Title: Lay Summary: (5) Detailed Scientific Research Proposal for Studentship (max 1000 wds). Please provide details of the background to the research being proposed, describe the hypothesis to be tested, the methods of research to be used, relevant references and any preliminary data which supports the application. Also include how this research will potentially benefit patients in the future and impact on the career of the principle applicant 2 (6) Estimated Costs of Studentship Proposal. Please provide a breakdown of the research costs associated with the proposal and justification for such funds including student stipend and consumable funding. A maximum of £5,000 per year will be considered for consumable funding. Please add extra lines where required. Item Justification Cost TOTAL 3 (7) Funding source for support of remaining 50% of Studentship. As mentioned above, the AAIR charity will only support 50% funding of the student stipend, fees and consumables. Please provide details of where the remaining 50% support will come from (i.e. already secured funds or potential funding sources). Please add extra lines where required. If the answer to 11a is ‘yes’ then please complete section 11b. If the answer to 11a is ‘no’ then please complete section 11c. (a) Have you already obtained funding for the remaining 50% cost of the studentship. Yes No (b) If you have already secured funding, which research body(s) awarded the studentship and what are the details of the award including start date? (c) If you have not secured funding where do you intend to apply and when will you know the outcome? (8) Future plans (max 150wds). Please indicate how the support of the AAIR charity for the current PhD studentship proposal, if successful, would be beneficial to the applicants future research and career (9) Previous Research Students supervised by any of the applicants. Please provide the names of all supervisors, source of funding, degree registered for, start date and date of award of degree Student’s Supervisor(s) Source of Degree Start Date Award Date Name Funding 4 (10) Previous AAIR Charity Awards. Please provide details of any previous awards from the AAIR charity and include the outcome of such support (e.g. preliminary data for external grant application, collaboration etc). Please copy this page if necessary Title of Project: Nature of the Award: (e.g. consumables, equipment, salary) Date of Award: Amount of Award: Outcome of Award: (11) Supervisor signature(s) The success of AAIR depends on raising funds to support research. To facilitate this on-going process, successful applicants agree to: Write a brief yearly report and a final report at the end of the support explaining how the research support has been used. This will be for publicity purposes and should be written in lay language for the AAIR charity website and other promotional documents. Support the AAIR Charity in other ways depending on your circumstances and skills e.g., give a short talk at a fundraising event, participate in a sponsored run, assist with the development of charity documents or show AAIR charity visitors around your laboratory and equipment. Include an acknowledgement to the AAIR Charity on all publications and presentations resulting from this funding. Please inform the charity of all such research outputs. Signature of principle supervisor Date: Signature of co-supervisor(s) (if any) Date 5