Tropical Agriculture Award Fund Application Form International Study Awards (eight week awards for MSc students) Personal Information Surname M/F First Name Middle name Permanent Address Address for correspondence Telephone Current Email Permanent Email (if different) Date of Birth Nationality Passport No Health Do you have any medical condition that could affect your ability to work in a remote area? If so please attach a letter from your GP confirming that you are fit to undertake your proposed assignment Education Most recent first (include current course) and only back to A levels From To Name and location of institution Qualifications gained Title and content of Full/partcourse time Languages Please rate whether 1: fluent, 2:working knowledge or 3: basic Language 1 2 3 Employment History From To Organisation Description of (Name, address and type) post held Responsibilities Reasons for leaving Please account for any periods not covered elsewhere. Interests Please give details of spare time activities that are relevant to your application such as voluntary work. Also demonstrate your interest in development issues and/or your research interests. Give positions of responsibility held. Activity Position Future Career What field of work do you hope to follow in planning your future career? 2 Project to be undertaken for MSc dissertation Please expand the boxes as necessary in order to give the information needed, however, the project description and justification should not exceed two sides of A4 Name of project Country Host Institution Period you plan to be there Start date End date Detailed description of the project (aims and objectives; study area; methodology; expected results) Please explain how this field assignment benefits and links into your MSc course Description of the host/employing organization (and website if available): please confirm their willingness to host you (attach copies of relevant correspondence) and indicate what support they will offer Wider relevance and impact of the project (with particular reference to the objectives of the TAAF) 3 Please provide a detailed budget breakdown and total expenses. Examples of eligible costs are given in the table. Please insert additional rows as required. Item Return Airfare Visa costs Medical costs (e.g. vaccinations/malaria prophylaxis) Subsistence costs In-country travel expenses Research equipment Translator/field assistant costs Other (please specify) Cost Total Have you applied for or received any other award or grant towards funding of your participation in the project? If yes, what is the total of other awards (do not include personal savings or loans)? Please give a breakdown of other funding sources, and specify if the contribution covers a particular budget item (e.g. airfare, or research equipment). Use the table below as a guide. Other funding sources Indicate how much has been secured and what it covers or whether the application is still pending University/College grant (please specify) Other charitable body (please specify) Private sector grant (please specify) Personal savings Loan Other (please specify) References Applicants should request their Course Supervisor and Head of Department to send emailed references to taa_award_fund@taa.org.uk and secretary_taaf@taa.org.uk before the closing date for receipt of applications. For further guidance please refer to the Call for Applications for International Study Awards. Supervisor details (name, address, telephone, e-mail, position) Supervisor comments Head of Department (name, address, telephone, e-mail) Head of Department endorsement 4