JWT Jones Travelling Fellowship Application Form Applications are considered in February, May, August and November. Applications should be emailed to travelgrants@rsc.org or posted to: Travel Grants Administrator Royal Society of Chemistry Thomas Graham House Cambridge Science Park, Milton Road Cambridge CB4 0WF Please read the Terms and Conditions for JWT Jones Fellowships prior to completing this form. Full name and title: (IN BLOCK CAPITALS) RSC Membership number Date of Birth Address of University, research establishment, etc. Email Tel no. Position held Academic Qualifications Fax no. Field of Specialisation Major recent publications (maximum of 6) Name of applicant’s head of department sponsoring the overseas visit (A signed supporting statement must be provided with this application form. This should comment on the appropriateness to the home department of the work to be carried out by the applicant, bearing in mind the availability of equipment or the intention to acquire such equipment) Proposed place of Study Full name and address of head of department to be visited (Supporting evidence must be provided in the form of a letter from the host indicating that he/she fully understands the nature of the scheme; realises that no funds are available as a contribution to research costs, apparatus or bench fees; welcomes the projected visit; and considers the proposed period of the visit adequate for the project’s satisfactory conclusion) Period of visit (Include estimated date of departure and return if known, indicate how long you intend to be abroad) Purpose of proposed visit (It is not sufficient to state in broad terms that you wish to carry out research or learn new techniques. Applicants must provide a clear and concise statement, in their own words, of the background to the project and the technique or research methods to be used. You must make it clear how it will be established and applied in your own laboratory and who else might benefit. It would also be useful to explain why the institution you wish to visit is the most appropriate. Separately, you should provide evidence that the programme is acceptable to the host department) Financial details of grant requested (Funds cannot be used for attendance at scientific meetings or courses, or for normal research costs or bench fees) Travel Subsistence Other expenditure (description and cost) Total Not to exceed £5000 State other sources of funding applied to and amount requested: Will you be in receipt of your present salary during the term of the Fellowship? (only applicants already in post will be eligible to receive an award) Name address of referee Email address of referee Please provide details of any other grants received or applications pending, in connection with the proposed visit Declaration I am a member of the Royal Society of Chemistry and understand that if awarded a Fellowship, I shall submit a report of approximately 500 words shortly after the completion of the visit. I will also acknowledge receipt of a JWT Jones Travelling Fellowship in any publication resulting from the stay abroad. Signature of Applicant Date The above application is made with my full support Signature of Head of Department Date