DE Scholarship Application - Association of University Technology

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The 2016 Scholarships for New Technology Transfer Professionals
from Developing Economies
About the Scholarships
The 2016 Scholarships for New Technology Transfer Professionals from Developing
Economies1,2 (the Developing Economies Scholarship) will be awarded to up to five (5)
individuals. These scholarships will:

Be awarded to individuals new to the discipline who come from countries that are
building technology transfer infrastructure and organizations.

Provide support to attend an AUTM sponsored or co-sponsored meeting or course
identified by the candidate up to a maximum level of $US 4,000, with a requirement that
the applicant’s home institution fund no less than 20% of the budgeted expenses3. The
scholarship must be used to attend an AUTM event in 2016.

Enhance learning opportunities for members of AUTM who might not otherwise be able
attend AUTM sponsored or co-sponsored meetings or professional development
courses.
Qualifications
Candidates for the Developing Economies Scholarship must:
1. Either be members of AUTM or, if selected, join AUTM prior to receiving the
award4;
2. Be employed as a technology transfer professional in an academic or not-for-profit
institution in a qualifying country;
3. Have less than two years of experience as a full time technology transfer professional;
4. Have a sufficient command of the English spoken language to be able to benefit from
and participate in an AUTM meeting or course.
Nominations
 Individuals may be self-nominated, or nominated by an active AUTM member.
Candidates must submit the requested information via the application form available
through AUTM.

There is no limitation on the number of applications from either a single institution or
country, and each application will be judged on its own merit.
Application Deadline
Applications must be received by August 31, 2015.
“Developing Economies” are those countries that are emergent in level of economic activity or impact on the
world economy as defined by the World Bank – see attached list.
2
AUTM reserves the right to alter the list of Countries with Developing Economies and the list of Least Developed
Economies based on classifications and definitions used by the World Bank, and based on any applicable United
States export control regulations or laws.
3
All eligible budget expenses and categories are outlined in application package. The requirement for a minimum
20% co-funding from the home institution is waived for applicants from the listed Least Developed Economies.
4
Applicants need not be members at the time of application, but if not members, then an AUTM membership must
be included in the budget.
1
How to Apply
 Complete the Developing Economies Scholarship application

E-mail the application, a copy of your resume and an institutional letter of support to
AUTM headquarters at slee@autm.net

If e-mail is not an option, fax or express mail to:
AUTM
DE Scholarship
111 Deer Lake Road, Suite 100
Deerfield, IL 60015 USA
Phone: +1-847-559-0846
Facsimile: +1-847-480-9282
Selection
An AUTM subcommittee will make the final recommendations based upon applications received
by the deadline and AUTM will announce the recipients of the 2016 Developing Economies
Scholarships in early November.
Selection will be based on
1. AUTM goals and guidelines for the scholarships including the awarding of at least one
scholarship to a qualifying applicant from a Least Developed Economy;
2. The candidates’ applications outlining their current activities in the field, future potential
contributions to the profession and their institutions, and the appropriateness of the
budgets submitted; and
3. The commitment shown by their home institutions in the form of the letter of support and
financial commitment.
Countries with Developing Economies as Identified by The World Bank
The eligible countries for the scholarship are as follows:
Afghanistan
Albania
Algeria
Angola
Antigua and
Barbuda
Argentina
Armenia
Azerbaijan
Bangladesh
Belize
Benin
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Central African
Republic
Chad
Chile
China
Colombia
Comoros
Congo, Rep.
Costa Rica
Croatia
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt, Arab Rep.
El Salvador
Equatorial Guinea
Eritrea
Ethiopia
Fiji
Gabon
Gambia, The
Georgia
Ghana
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
India
Indonesia
Jamaica
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Rep.
Kosovo
Kyrgyz Republic
Lao PDR
Lesotho
Macedonia, FYR
Madagascar
Malawi
Malaysia
Maldives
Mali
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia, Fed Sts
Moldova
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nepal
Nicaragua
Niger
Nigeria
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Romania
Russian Federation
Rwanda
Samoa
São Tomé Principe
Senegal
Serbia
Seychelles
Sierra Leone
Solomon Islands
South Africa
South Sudan
Sri Lanka
St. Kitts and Nevis
St. Lucia
St. Vincent and the
Grenadines
Suriname
Swaziland Republic
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and
Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Uruguay
Uzbekistan
Vanuatu
Venezuela, RB
Vietnam
Zambia
Least Developed Economies (LDE)
One scholarship will be reserved for qualifying applicants from any of the following countries:
Afghanistan
Bangladesh
Benin
Bhutan
Burkina Faso
Burundi
Cambodia
Cameroon
Central African
Republic
Chad
Comoros
Congo, Rep.
Djibouti
Eritrea
Ethiopia
Gambia, The
Ghana
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Kenya
Kiribati
Kosovo
Kyrgyz Republic
Lao PDR
Lesotho
Madagascar
Malawi
Maldives
Mali
Marshall Islands
Mauritania
Micronesia, Fed Sts.
Mozambique
Myanmar
Nepal
Nicaragua
Niger
Nigeria
Rwanda
Samoa
São Tomé and
Principe
Senegal
Sierra Leone
Solomon Islands
South Sudan
Tajikistan
Tanzania
Togo
Tonga
Tuvalu
Uganda
Vanuatu
Zambia
DE Scholarship Application
GENERAL INSTRUCTIONS
Qualifications:
Applicants must:
1. Hold active membership in AUTM at the time of receiving the award. Applicants need not be
members at the time of application, but if not, then a membership must be included in the proposed
budget. For membership information, visit www.autm.net/join.
2. Be employed in the technology transfer profession working in an academic or not-for-profit
institution in a qualifying country. (Refer to the attached list to determine which countries are
qualifying countries.) Note that this scholarship is for capacity building through professional
development within the profession of formal academic technology transfer. The scholarship is not
intended to support educators or researchers studying technology transfer or those engaged in
consulting or providing for-profit services for technology transfer or government policy advising;
3. Have less than two years of experience as a full time technology transfer professional; and
4. Have a sufficient command of the English spoken language to be able both to benefit from, and to
participate at an AUTM meeting or course.
The Developing Economies Scholarship application consists of the following sections:
1. Part I A and B:
General Applicant Information and Curriculum Vitae
2. Part II A and B:
Written Questions, Financial Information and Summary Budget
3. Part III A and B:
Signatures of Applicant and duly authorized representative of Applicant’s
Institution
4. Part IV Attachment:
Letter of Support from the Home Institution of the Applicant
SPECIFIC INSTRUCTIONS
1. FINANCIAL INFORMATION FOR SUMMARY BUDGET
The summary budget in the application for the Developing Economies Scholarship includes a list of
approved expense items that may be considered as components of the applicant’s proposed budget to
AUTM. All applicants are required to submit a budget in the given format. A letter of support from the
applicant’s institution must guarantee the co-funded component of the budget which will not be covered
by the scholarship. The co-funded component of the budget is required to be no less than 20% of
the total budgeted costs unless the applicant is from a LDE-listed country. The total AUTM
contribution must not exceed $US 4,000.
Air Travel. Defined as all air travel expenses associated with travel from home country of applicant to the
closest major airport to the location of the AUTM course or meeting. All international travel must be at the
lowest cost, economy round-trip airfare available from the home country of the applicant.
Hotel Accommodations. Defined as all direct hotel accommodation expenses and local taxes (excluding
incidental room charges such as phone calls, room service, etc.) incurred in the city where the AUTM
event is occurring; hotel to be the one recommended by AUTM for the event. For travel to an AUTM
event, the maximum single stay for which AUTM will provide support for any one individual is five nights.
Per Diem Expenses. Defined as Meals and Incidental Expenses (M&IE) not covered by the AUTM event;
the daily per diem rate allowed is $US 50.00.
Ground transportation. Ground transportation is defined as all non-air travel expenses (such as local
taxis, train, etc.) associated with transport to and participation in an AUTM event.
AUTM Course or Meeting Registration Fee. The cost of attending an AUTM sponsored or cosponsored course or meeting. (Approximately $US 450-800)
**The applicant, host institute or other local funding source, must pay these expenses.
Visa Fees. ** These fees in support of applicant’s entry into the country of the AUTM sponsored or cosponsored meeting or course must be paid and budgeted by the home institution.
International Health & Travel Insurance.** International health insurance is required for applicant
eligibility in this AUTM grant program. This must be paid and budgeted as a local expense to be paid by
the applicant/home institution or other local, non-AUTM funding source prior to leaving the home country.
If exact cost is unknown, estimate $US 60 per week, and submit evidence of purchase to AUTM as a
component of this application form.
2. LETTER OF SUPPORT FROM HOME INSTITUTE
To be eligible for consideration, applicants must submit a Letter of Support to AUTM from their home
institution signed by a duly authorized representative, in which the institution commits its support for the
applicant, any dissemination plan and guarantees any funds (or those of a third party) as specified in the
Summary Budget. The Letter of Support must be on the home institution letterhead, signed, and mailed
or faxed directly to AUTM by the Applicant with their application.
See End of Application for a Sample Letter
DE Scholarship Application
Complete the following form and submit to AUTM for review. Incomplete applications and applicants who do not
meet qualifications will not be considered. Note that AUTM may request additional information for consideration.
Failure to comply with requests for supporting information could be grounds for disqualification.
Remember the Application Deadline is August 31, 2015
PART I A – GENERAL APPLICANT INFORMATION
Given/First Name
Surname/Family Name/Last Name
Title
University or Institution Name
Address
City
State/Province
Country
Postal Code
Phone (Indicate: work, home or mobile) Alternative Phone (Indicate: work, home or mobile)
Email
Fax
PART I B – APPLICANT CURRICULUM VITAE
ATTACH A COPY OF YOUR CURRICULUM VITAE (RESUME)
PART II A – APPLICANT QUESTIONS AND BUDGET:
QUESTIONS:
Answer all questions completely but in brief, i.e. in fewer than 200 words.
a. Provide a short description of your institution, focusing on:
(i) Major research activities
(ii) Technology transfer infrastructure and activities (mention the age and size of your office)
(iii) Governmental policies and technology transfer support programs
b. Describe your role in your institution and your role in implementing your institution’s technology transfer
policy and activities. Include a summary of your experience so far in technology transfer and any AUTM
events you have attended so far.
c. What are your personal career goals in technology transfer and what areas of technology transfer interest
you most?
d. Which AUTM event do you wish to attend and why? AUTM hosts many meetings and training courses
(national, regional and international) throughout the year – a list of upcoming events can be viewed on the
AUTM website, www.autm.net/events. A winning candidate may attend any AUTM meeting or course of
his/her choosing but must specify it at this time. You should also indicate how this scholarship and
attendance at this AUTM event will help you achieve your goals as a technology transfer professional.
e. A strength of AUTM as represented by the professionals comprising it, is the willingness of its
membership to share expertise. Describe your plan to share what you have learned at AUTM with other
people at your home institution and/or in your region on your return? Note: AUTM will request information
on the success of this plan six months after event attendance.
PART II B - SUMMARY BUDGET
Unless you are applying from a country on the attached Least Developed Economies listing,
the Home Institution must contribute at least 20% of the total budget as set out below.
I am applying from a LDE listed country: __yes ___no
Category
Amount Requested
From AUTM
(in U.S. Dollars)
Amount To Be
Provided By
Institution or
Other Non-AUTM
Source
(in U.S. Dollars)
Notes
Air Travel
From Home to Nearest
Airport to Event
Ground Travel
Expenses
Taxi, Bus or Train etc.
Hotel
Accommodations
AUTM recommended
accommodation for venue
AUTM Registration
Fee
AUTM Meeting or Course
AUTM Membership
Fee
If Not A Member
Per Diem Expenses
(daily meals, etc. )
Meals, etc., other than
those covered by meeting
Health Insurance**
Must be covered by
Home Institution
Visa Fees**
Must be covered by
Home Institution
AUTM Contribution $
Requested
(Not To Exceed $US4,000)
Home Institution
Contribution
$
Must be not less than
20% of Total Budget,
unless from LDE listed
country
Total Budget $
**If you are not applying from LDE listed country, health insurance and visa fees must be paid by the
host institution or other non-AUTM funding source.
PART III A – APPLICANT SUBMISSION AND SIGNATURE
Application Deadline: The application deadline is August 31, 2015.
Send your completed application to AUTM:

By email to: slee@autm.net

Or by fax to: +1-847-480-9282

Or by express mail to:
Subject line: AUTM DE Scholarship Submittal
AUTM
Attention: DE Scholarship
111 Deer Lake Road, Suite 100
Deerfield, IL 60015
Telephone: +1-847-559-0846
NOTE: Applications should only be submitted once either by fax, email or mail. If you are unsure whether
your application has reached us, contact Sheila Lee at slee@autm.net to ensure it has been received.
I wish to be considered for support under the AUTM Scholarship Program to Attend:
_______________________________________________
AUTM Sponsored or Co-sponsored Event
Applicant Signature
Print Full Name
Date
PART III B – HOME INSTITUTION ATTESTATION OF SUPPORT
Applicant: Ensure that you attach a letter of recommendation in support of your application from your
Institution (employer) as well as having an authorized institutional representative sign below. A sample letter is
provided in these instructions. The contents of the letter should cover all of the information outlined in the
instructions.
Note: Given the complexities of international travel today, AUTM requires clear acknowledgement of
the responsibility of your institution to:
1. Meet the costs and relevant administrative requirements of your visa application to attend either an
AUTM meeting or course; and
2. Ensure Health and Travel Insurance cover for the applicant for any illness or accident that might occur
during the period of traveling to, from and while attending the AUTM event.
By signature below the Home Institution indicates its support for this applicant’s application and travel
to the AUTM event should the scholarship be awarded:
Institution Authorized Signature
Print Full Name
Date
PART IV– HOME INSTITUTION LETTER OF SUPPORT
Home Institution Sample Letter– Fill Out and Copy on to Letterhead
[DATE]
Reference for: [Applicant Name]
AUTM
111 Deer Lake Road, Suite 100
Deerfield, IL 60015 USA
Dear AUTM,
This letter is a commitment by this institution to support the professional development of
[Applicant name] by allowing them to attend the AUTM meeting or course indicated in the
enclosed application and to provide [Fill in US $X] as a cash contribution in support of
[Applicant name] for the enclosed application submitted to AUTM.
This letter hereby confirms that [Applicant name] is new to the profession and has been active in
technology transfer at our institution for a period of no more than two years.
On behalf of this institution, I guarantee [Fill in US $X] the following direct contributions (or
guarantee of other third party support) to this Scholarship and as part of this will be fully
responsible in ensuring all of the appropriate fees, applications, and insurance are covered as per
travel Visa and full Health / Travel Insurance coverage:
Cost
(U.S. Dollars)
BUDGET CATEGORY
1.
Applicant cost of Visa Fees
[Fill in US $A]
2.
Applicant cost of purchasing International Health
and travel Insurance fees
[Fill in US $B]
3.
Additional Contribution to be provided
For _______________________________
[Fill in US $C]
Home Institution Total Commitment
$ [Fill in US $X=A+B+C]
It is understood that proof of Health and Travel Insurance coverage may be requested by AUTM.
The terms of this commitment letter will expire one (1) year from the execution date unless the
scholarship is approved by AUTM and accepted by the recipient, whereupon it will expire when
the commitment is fulfilled or the recipient does not accept the scholarship.
Sincerely,
____________________________________________
Signature Home Institution Authorized Representative
____________________________________________
Printed Name
____________________________________________
Title
__________________
Execution Date
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