Qualitative Health Research Writing Group Network Residential Writing Retreat – Application Form Shepherds Dene, Northumberland, June 17th-19th 2015 Please email completed application forms to firstname.lastname@example.org by Monday 1st June. Name: Institution and Department: Email Address: Phone Number: Career Stage: (i.e. Research Assistant, PhD Student (please state year), PostDoc (please state year of PhD completion)) Summary of your research: (Max. 200 words) Anticipated outputs from retreat: (Please state specific, achievable outputs, i.e. a paper on a specific piece of your research, a thesis chapter etc.) Are you a current member of the QHRWGN? Are you an unfunded student who would like to apply for one of the two retreat bursaries?