ACT BRC NMAHP fellowship application form 2014

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Addenbrooke’s Charitable Trust and Biomedical Research Centre
Nurses, Midwifes and Allied Health Professional (NMAHP)
Research Training Fellowship Application
Please send an electronic copy on this form to christideatonpa@medschl.cam.ac.uk by 12.00 midday on
Monday 1 December 2014.
This form is divided into five sections:
1.
2.
3.
4.
5.
Applicant details
Summary of proposal
Outline of proposal
Applicant CV
Supervisor/s CV
1. Applicant details
Lead applicant:
Surname, Forename, Title
Address for
correspondence:
E-mail address:
Landline number/s:
Mobile number/s:
Bleep (if applicable):
Current Position:
Address where
research will be
conducted:
University and
department where
doctoral studies will
be undertaken:
2. Summary of proposal
Title of Research
Proposed for Doctoral
or Post-Doctoral
Fellowship:
Proposed Start Date:
Proposed plan for
fellowship
Time and activities to support
development of award
application – maximum 250
words
Nurses, Midwifes and Allied Health Professional (NMAHP)
Research Training Fellowship Application
Summary of proposed
research:
maximum 250 words
Lay summary of
proposed research
maximum 250 words
Salary support
requested
Please check costs with the
Medical Staffing (CUH
employment or Cambridge
University)
a)
b)
c)
d)
e)
Proposed employer
Salary
NI
Superannuation
Total
A contribution towards consumable costs will be made if the application is successful.
Nurses, Midwifes and Allied Health Professional (NMAHP)
Research Training Fellowship Application
3. Outline of proposal
Please provide a one page outline (minimum font size 10) of your proposed research
Nurses, Midwifes and Allied Health Professional (NMAHP)
Research Training Fellowship Application
4. Applicant CV
ACT / BRC Nurses, Midwives and Allied Health Professional (NMAHP)
Research Training Fellowship Scheme
Applicant’s CURRICULUM VITAE
Name
Current position
Previous positions (please list in chronological order, starting with the most recent)
Degrees
Please describe any previous research experience, and describe how the fellowship will further the applicant’s
career (max 300 words)
Publications (list up to 5 publications)
Nurses, Midwifes and Allied Health Professional (NMAHP)
Research Training Fellowship Application
5. Supervisor/s CV
ACT / BRC Nurses, Midwives and Allied Health Professional (NMAHP)
Research Training Fellowship Scheme
Supervisor’s CURRICULUM VITAE (please duplicate this page for additional supervisor)
Name
Address
Email
Tel.
Current position
Previous positions (please list in chronological order, starting with the most recent)
Degrees
Research Support (please list research grants awarded during the last 5 years)
Graduate student supervision
Number of students supervised:
MPhil
PhD
Number of students who have completed their degrees:
MPhil
PhD
Publications (list up to 5 recent publications relevant to the proposed project)
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