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Faculty of Mathematical & Physical
Sciences
Carnegie UCL Collaborative
Visiting Doctoral Student Scheme
Application Form
CHECKLIST
Has the required supporting documentation been
attached?
Have you attached a printout of the up-to-date Student
Log
Have the Statements been provided and the form signed
by the UCL Supervisor, the Carnegie Supervisor and
HoD/Departmental Graduate Tutor?
Please submit by the relevant deadline (see Guidelines).
Note that applications submitted without the correct
supporting evidence will be rejected.
Please read the guidelines carefully before completing this form. Please TYPE or complete in BLOCK capitals.
Please complete all sections. Incomplete applications will be returned.
1. Academic Supervisor Details
Applicant’s full name (UCL Supervisor) (please print):
Department:
Full name of Carnegie Supervisor (please print):
UCL Supervisor’s department (for correspondence):
Email:
Tel:
Supporting Statement:
 Please indicate the relationship of the proposed trip to the student’s thesis, and the benefits you consider the student/research will gain
from the visit.
 Please confirm that this visit is not likely to impact negatively on the student’s ability to complete within the prescribed period of their
programme.
 Please confirm that there will be regular communication between the UCL supervisor(s) and the visiting student for the duration of the visit.
This must be a minimum of one contact per week for the length of the visit, via Skype, email or phone. For longer visits it should preferably
involve a visit by the Supervisor.
Signature of UCL Supervisor:
Date:
Signature of UCL secondary supervisor:
Date:
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2. Student Details
Title:
First name:
Family name:
Department:
Address (for correspondence):
Email:
Tel. no:
Fee Status:
UK/EU
Overseas
Will a visa be required for entry to USA?
Further assistance can be obtained from the Study Abroad office or the UCL Student Immigration Compliance Manager, Joanna Page
Yes
No
Please state any Scholarships/Studentships held:
Principal supervisor:
Subsidiary supervisor:
Please give details of undergraduate / Master’s degrees or equivalent:
Degree/s
Obtained
Subject
Year of
Graduation
Class of
Honours
College or University
Full or
Part-time
Full name of Principal Supervisor
Please give details of current research degree registration:
Current
Degree
Subject
Date of
Registration
Please give the title / provisional title of your thesis:
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3. Proposal
Proposed Carnegie Department and Supervisor:
Proposed Start Date:
Proposed End Date:
Note: visits will normally be for a period of three months, but other periods of time specifically agreed to by all parties may be considered.
Please state how the visit will benefit the research programme, detailing the specific questions and aspects of work the student will be
investigating there. Please provide information on what are the plans to engage with the Carnegie research community beyond the confines of
the individual project and comment on how else this visit will benefit the Doctoral students (max 500 words).
Proposed Source of Funding for the visit:
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4. Estimated Costs & Contributions
Exchange Rate (if applicable - please use the www.xe.com currency converter):
£1 =
£
Travel: (please give details)
Total Travel:
£
Total Accommodation:
£
Total Subsistence:
£
Total Research Expenses:
£
Total Estimated Expenses:
£
Accommodation:
No. of nights:
Cost per night:
Subsistence:
Research Expenses/consumables (please give details):
Amounts assured from Carnegie and any other organisations (please give source, amount and evidence of
confirmation, and attach copies of relevant documentation):
£
Signature of applicant (UCL Supervisor):
Date:
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5. Carnegie Supervisor’s Endorsement
Full name of UCL Supervisor (applicant) (please print):
Full name of UCL Doctoral Student (please print):
Full name of Carnegie Supervisor* (please print):
Carnegie Supervisor’s address (for
correspondence):
Email:
Tel:
Supporting Statement:
Additionally, please confirm that the provisions stated in the application will be made available by
Carnegie.
I confirm that the following facilities will be made available to the student nominated: (please tick all that
apply):
☐ Desk space
☐ Computing facilities
☐ Access to research laboratories
☐ Library facilities (physical or online)
☐ Access to regular interaction with researchers (e.g. seminars etc)
Signature of Carnegie Supervisor*:
Date:
*Please note that colleagues at Carnegie acting as tertiary supervisors to UCL students will need to be
approved to act in this capacity by the MAPS Faculty Graduate Tutor and hold an honorary contract from
UCL. Please complete the PhD Supervisor Approval request form at http://www.ucl.ac.uk/mathematicalphysical-sciences/intranet/ResearchSupervisors
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6. Head of Department’s Endorsement *
I support this application:
strongly
moderately
I do not support this application
 Please indicate whether you consider that this student will be a good ambassador for the Department/UCL
 Please indicate how this area of research links with strategic departmental/discipline aims
 Please indicate whether you consider that any on-going links with Carnegie are likely to be fostered via this visit.
Head of Department’s Signature (* May include the HoD’s appointed representative, e.g. the DGT):
Date:
Name (please print):
Ext:
NOTE TO APPLICANTS:
1. Please see CHECKLIST on front of form before submitting the application.
2. Please submit by the deadline stated in the Guidelines. Submission is welcomed either by either email to
maps.students@ucl.ac.uk or in hard copy to:
Mathematical & Physical Sciences Faculty Office, South Wing, University College London, Gower Street,
London WC1E 6BT
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