Dorey Bequest Sir William Lister Awards Application Form 2015

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Education and Training Department
Sir William Lister and Dorey Bequest Travel Awards
2015
Closing date: Wednesday 23 September 2015
Multiple awards of £300 – £600
The Education Committee of the Royal College of Ophthalmologists has become responsible for a
number of travel awards in recent years. The administrative process for the above two travel awards
has been amalgamated for the purposes of application.
i.
ii.
iii.
iv.
i.
ii.
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v.
Please note:
Applicants will be considered for a travel award but will be awarded from one fund only (e.g. you
cannot receive a travel award from the Dorey Bequest and Sir William Lister).
Those who receive a travel award will be informed from which fund their award is from.
Those who have received a travel award from the Ethicon Foundation Fund are not eligible to apply.
Retrospective applications will not be considered.
General Information:
The Royal College of Ophthalmologists has undertaken the role of trustee and administrator for the
funds. For Sir William Lister, this has been assumed from the Royal College of Surgeons of England.
The travel awards will be made by the Education Committee of the Royal College of
Ophthalmologists.
The award is for ophthalmologists in training who are citizens of the United Kingdom as well as
Members and Fellows of the Royal College of Ophthalmologists, in good standing.
Successful applicants will submit a report to the Education Committee on completion of the period
of training or research for which the award is granted.
The number and value of the awards will be determined by the state of the funds and the candidate's
requirements; the amount awarded is generally between £300 and £600
ii.
Sir William Lister:
Founded in 1948 with a gift of £3,000 by Lady Lister in memory of her husband, Sir William Tindall
Lister KCMG KCVO.
The title of the award shall be the Sir William Lister Award in Ophthalmology.
i.
ii.
Dorey Bequest:
Founded in 1992 with a gift of £17,000 from Mr Corry James Dorey.
The title of the award shall be the Dorey Bequest.
i.
Please email an electronic version of your completed application form and CV to:
Daniah.Ahmed@rcophth.ac.uk .
In addition to this, please post 4 hard copies of your application form and CV to:
Daniah Ahmed
Education and Training Administrator
The Royal College of Ophthalmologists
18 Stephenson Way
London NW1 2HD
(Your application will be disqualified unless we receive both electronic and hard copies of your
application form and CV.)
CLOSING DATE FOR APPLICATIONS: Wednesday 23 September 2015
Sir William Lister and Dorey Bequest Travel Awards
Application Form
Closing date: Wednesday 23 September 2015
Personal Details
Title
Name
Surname
Email Address
Mobile Number
College Membership Number
National Training Number
(NTN)
Qualifications held
Work Address
Tel No
Fax No
Post Held
Address for correspondence
(if different from above)
Details of Visit
Start date
Duration
Title of Fellowship/Research
Project
Place of Fellowship/Research
Project
Financial Statement
Cost of Travel
Does the post attract a salary?
(If yes, please indicate amount)
Will a UK salary be retained?
(If yes, please indicate amount)
Other grants/fellowships
obtained or being sought
Nature and purpose of proposed visit:
(N.B. This should include aims and objectives of the visit/research and suitability of the
centre to be visited or to accommodate the research. Please note that this page must
be used for a summary but an appendix can be attached if it is felt necessary.)
THIS SECTION IS TO BE COMPLETED BY CURRENT UK TRAINER / HEAD OF
DEPARTMENT
Statement of support
Name
Title
Signature
Date
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