BOA General Travelling Fellowship 2014
Application Form B
Please complete and return this application form accompanied by a copy of your full CV by 31st October
2014. For more information, please visit the BOA website http://www.boa.ac.uk/training-education/boatravelling-fellowships/ or email Rayshum Notay at r.notay@boa.ac.uk. Applicants may only use either
application form A or B, not both, as explained at http://www.boa.ac.uk/training-education/how-do-iapply/.
All applications for the BOA Travelling Fellowships are considered by the BOA’s Education Committee.
Applicants must be trainees who are current members of the BOA and awards will not be made to ‘top up’
funding already obtained from other sources.
This application form has been designed for those Associates that wish to apply for a BOA General Travelling
Fellowship. Please note that these fellowships are subject to funding. These include:
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B Braun Travelling Fellowship
BOA European Travelling Fellowships
BOA Travelling Fellowships
Ram Kumar Chatterjee Travelling Fellowship
Soli Lam General Fellowship
Singhal Travelling Fellowship
x 1 @ £2,000*
x 2 @ £1,500*
x 2 @ £5,000
x 1 @ £3,000
x 1 @ £3,000
x 1 @ £1,500
*Applicants unsuccessful in the B Braun Travelling Fellowship but ranked highly may be awarded a capped
award for £1,500 as a BOA European Travelling Fellowship, if the proposed fellowship is in Europe or a
Singhal Travelling Fellowship.
SURNAME:
[Prof / Mr / Dr / Mrs / Miss / Ms]
FIRST NAMES:
DATE OF BIRTH:
Home details
Hospital Details
HOME ADDRESS:
HOSPITAL ADDRESS:
TELEPHONE NUMBER:
(inc. dialling code)
TELEPHONE NUMBER:
(inc. dialling code)
MOBILE NUMBER:
FAX NUMBER:
(inc. dialling code)
FAX NUMBER:
(inc. dialling code)
EMAIL ADDRESS:
POSITION HELD:
REFEREES (must be BOA members):
[1]
[2]
Preferred Fellowship(s) you wish to apply for:
B Braun Travelling Fellowship
BOA European Travelling Fellowships
BOA Travelling Fellowships
Ram Kumar Chatterjee Travelling Fellowships
Soli Lam General Fellowship
Singhal Travelling Fellowship
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☐
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Short description of your prospective placement/ Fellowship (up to 100 words):
Proposed date of travel:
Estimated costs of travel and accommodation (these should relate to the costs of the individual
undertaking the fellowship only, and should correlate to the chosen fellowship(s) stated above.)
Cost incurred
Amount
Details of other funding received or applied for:
Will you continue to receive your salary on top of any fellowship funding:
Please provide details of your proposed placement/ Fellowship. Describe what you hope to achieve from
the placement, including any particular skills you would like to acquire and give details of any research
projects you would like to undertake (please provide a maximum of 2 pages. This section will expand as
you type).
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The closing date for application is 7th November 2013. Shortlisted candidates will be required to attend an
interview on Friday 10th January 2014.
Please send your CV as a separate attachment with your application, including:
•
Chronological list of posts held from graduation to present.
•
List of scientific publications by title, names of authors and journal.
•
List of manuscripts submitted for publication by title and journal
•
List of scientific presentations to national, international or local meetings
•
List of research projects in which you have participated
•
•
Prizes and awards you have received
List of professional organisations of which you are a member, indicating if you have served on any
committees of these organisations.