ANNE BOUTWOOD TRAVELLING FELLOWSHIP 2015
Application Form
Through the generosity of the Trustees of the Elizabeth Garrett Anderson Hospital Appeal Trust, the Council of the College
is able to offer an annual prize of £5000 to be awarded to one applicant each year. The award is called the 'Anne Boutwood
Travelling Fellowship'. Anne Boutwood was a founder member of the Elizabeth Garrett Anderson Hospital Appeal Trust who
sadly died in 2009.
The fellowship will be awarded to a trainee in obstetrics and gynaecology resident in the UK to facilitate travel overseas to
enable research or training for the purposes of personal development and to enhance the awardee’s contribution to the
specialty of obstetrics and gynaecology.
On return to the UK, the successful candidate will receive a certificate and may be expected to present a short lecture of
their experience at an RCOG event, a University College of London Hospital event, or both.
Prize: £5,000
TO APPLY:
Please send the following documents to the Awards Administrator by email OR post by Sunday 24th May 2015
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Completed application form
An essay of not more than 2 sides of A4 providing details of the project.
The first paragraph should be in bold and not more than 4 lines to capture the essence of the proposed plan.
Two references from Fellows in clinical practice (see Section 3)
A short Curriculum Vitae (maximum of four A4 pages) including university details
Confirmation from the institution to be visited that the visit has been approved
Awards Administrator
Royal College of Obstetricians and Gynaecologists
27, Sussex Place
Regent’s Park
London
NW1 4RG
E: awards@rcog.org.uk
Applications received after the closing date will not be accepted.
CONDITIONS
 Travel must take place within 12 months of the award being made in October 2015
 The award may only be used for the purpose approved by the Assessment Committee
SECTION 1
PERSONAL DETAILS
Name of applicant:
Current appointment:
(Grade and institution)
Work address:
Correspondence address:
(if different from above)
Telephone number:
Email address:
Date of birth:
SECTION 2
DETAILS OF TRAVEL
Details of Institution(s) to be
visited:
Have you enclosed
confirmation from the
institution that your visit has
been approved? (please tick)
Estimated duration of visit:
Planned departure date:
Estimated travel costs
including subsistence and
accommodation:
Please list details of any
other financial assistance
being requested and/or
obtained for the visit:
Yes
No
SECTION 3
REFEREES
You must provide TWO references from two Fellows in active clinical practice with this application.
Full details of referees:
SIGNED: _________________________________________________________________________
DATED: __________________________________________________________________________