DUTCH KIDNEY FOUNDATION
Application form
Kolff Student Fellowship Abroad Grant
Version 8 December 2015
The Dutch Kidney Foundation (DKF) General Funding Conditions (‘'Subsidievoorwaarden Nierstichting
Nederland'') apply to all awarded DKF subsidies as well as all proposals for DKF subsidies. Applicability of
general and other conditions of the applicant, the applicant's institute and of third parties is explicitly
excluded.
The execution of a DKF Call for proposals, selection of pre-proposals for full application and positive DKF
grant award decisions are conditional on DKF revenues and budgetary means. The DKF explicitly reserves
the right to cancel an initiated Call for proposals, to suspend a running procedure or to lower a grant amount
in relation to earlier statements.
Dutch Kidney Foundation
Nierstichting
+31 (0) 35 697 8011
subsidie@nierstichting.nl
Project code:
___________________________________________________________________
This code will be assigned by the DKF after receiving your application.
Please submit in digital format only (pdf).
Word counts given below are indications for the preferred maximal length of text.
Application date:
___________________________________________________________________
1. Title
2. Applicant, Project Leader in the Netherlands
Name (M/F)
Institute & Department
Address:
Name Institute
Department
Room number
Street name
Postal code, Town/city
Telephone
E-mail
Project leader of DKF
Projects (project codes
past 6 years if
applicable)
1
3. Student Fellow
Name (M/F)
Address (NL):
Street name
Postal code, Town/city
Address abroad:
Street name
Postal code, Town/city
Country
Telephone (NL)
E-mail
Date of birth
University (NL)
Study
Bank account (NL): bank
name, account number,
account holder
4. Project Leader Abroad
Name (M/F)
Institute & Department
Address:
Name Institute
Department
Room number
Street name
Postal code, Town/city
Country
Telephone
E-mail
5. Student Research Project
Expected start date
Expected end date
Duration
Proposed DKF Budget
6. Overall Research Project Abroad
Provide information of the project to which the Student Fellow will contribute.
Title
Project code
Project leader
Country, institute and
department
Funder of the project
Start date and duration
2
7. Summary of the Overall Research Project (max. 400 words)
8. Student Fellow Research Project (max. 500 words)
Describe the project and how it fits within the overall project. Include hypothesis, objectives, work plan and
time schedule.
9. Summary of the Research of the Supervisor Abroad (max. 400 words, max. 10 references)
10. Motivation of the Student Fellow
Written by the candidate.
11. CV of the Student Fellow
Written by the candidate.
12. Budget
Income (e.g. study grants and
financing, reimbursements,
private contributions)
Expected
Totals (in euros)
Proposed DKF budget
contribution (euros)
3
Expenses (e.g. travel expenses,
accomodation)
13. Signatures
The project leader abroad signs the letter of invitation.
Name, position, institute
Signature
Project leader (NL)
Student fellow
Authorized Head of
Institute (NL)
4
Date