EPSRC Doctoral Prize Fellowship Application Form
1.
PERSONAL DETAILS
Last Name / Family Name
First/Given Name(s)
Title
Address
Post Code
E-mail Address:
Evening
Telephone Number
Daytime
Mobile
2.
DETAILS OF EPSRC FUNDED PhD
PhD thesis title
Awarding university
Department or school
Name of supervisor
PhD start date
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3.
REFERENCES
Please give the names of two academic referees, one of whom should be your PhD supervisor, who could provide a
reference regarding your suitability for the post for which you are applying. Please note your nominated project mentor
cannot be named as a referee. You should provide each of your referees with a copy of your completed application form
and accompanying details about the scheme.
PhD SUPERVISOR
ACADEMIC REFEREE
Name
Job Title / Position
Address
Post Code
Tel number
E-Mail Address
May we request a reference prior to
interview?
4.
Yes
Yes
No
No
SUPPORTING INFORMATION
Title of proposed fellowship
Name of Project Mentor
Requested start date
Duration of project requested
Publications details: Please provide details of up to three of your best publications to date
1)
2)
3)
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5.
PROJECT PROPOSAL
Outline in a maximum of 600 words:
a) your main objectives and proposed research activities, together with timescales and targets to be achieved
b) Outline how this research builds on but is distinct from your PhD studies.
c) Outline the potential value of the proposed research (academic significance, impact, commercialisation
potential, as appropriate for your discipline)
(word count
6.
)
PERSONAL STATEMENT
Please outline how you consider your knowledge, skills and experience meet the criteria for the EPSRC Doctoral Prize
Fellowship. Also please provide details of your long-term aspirations and outline how you believe your career will benefit
from the award of this fellowship (max 500 words).
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7.
OUTREACH AND KNOWLEDGE TRANSFER ACTIVITIES
Please describe your proposed outreach activities within the project (max 250 words).
8.
DECLARATION
To the best of my knowledge and belief, the information contained in this form is accurate. I understand that giving false
information, or failure to supply details, will invalidate a fellowship offer.
Please note that, in submitting this application, you have accepted these terms, and agree to this declaration.
Signed:
9.
Date:
RETURN OF COMPLETED FORM
Applications must be submitted by midnight on Thursday 31 October 2013 by e-mail to s.hurson@qub.ac.uk.
Applications must include EPSRC Doctoral Prize Fellowship Application Form; Project Mentor Letter of Support
countersigned by the Research Cluster’s Director of Research; PhD Supervisor Reference Form; A brief CV – 1
A4 page in Arial font size 11 or equivalent. Incomplete applications will not be considered.
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