SCHOOL OF LITERATURE, ART AND MEDIA
Visiting Research Fellowship Scheme Application Form
CLOSING DATE: 25 March 2016 and 26 August 2016
The application form must be completed in full
Out-of-cycle applications may be considered in exceptional circumstances
Please refer to the Visiting Research Fellowship Guidelines
Title
Surname
Name
Citizenship
Business Mailing Address
Current Appointment
(including title)
Department
Institution
City/Town
Postcode/Zipcode
Country
Email
Proposed dates of visit (dd/mm/yyyy):
From:
To:
Project Title:
Host Department:
Department Contact Person:
Contribution to Program
Please indicate in which areas you are willing to contribute:
 Seminar
 Master Class
 Conference/Symposium participation
 Public Lecture
Checklist for attached documents
 Project Outline (750 words maximum)
 Research and Publications CV (5 page maximum)
 Letter of recommendation (Early Career Researchers ONLY)
Signature of Applicant:
Date:
Internal Use Only
Sponsor responsible for organising Fellow’s contribution to the program
Name
Statement of Support from the Sponsor
Please explain how the applicant’s proposed project fits with the departmental research activities or
interests. Indicate which of the contributions to the program that the applicant is willing to offer you
would host/organise and give an indicative timeframe.
Please certify degree of fit and recommend most suitable contribution to the program (see options on page 1)
Chair of Department supports application
YES
NO