RESEARCH MOBILITY PROGRAMME APPLICATION FORM Students (Please word process and send a signed hard copy and an electronic copy to your RMP Coordinator) Home University: Date of application: Date commenced PhD First name: Host University: Student number: How is PhD funded? Last name: Mr/Mrs/Ms Telephone no: Email: Department or School: Applicant’s address: Date of birth (required by some university systems): Proposed host institution: Host supervisor: Supervisor address: Telephone No: Email: Proposed project title: Proposed start date: Proposed end date: Please provide details of any research and academic links which already exist between your department / school and the department/school in the WUN partner institution. Details of funding to be applied for: Funding guidelines: (i) Travel: economy airfare, internal travel costs to host institution, and visa costs; (iii) Subsistence: up to equivalent £800 per month (maximum); (In exceptional circumstances additional funding may be available - please consult local RMP Coordinator) Item Detail Total Travel expenses Subsistence costs Research expenses (at the discretion of your university) Total claimed In no more than 1,000 words please provide information on the following in an attached, signed statement: (a) summary of the research you intend to undertake, detailing proposed interactions with the WUN partner institution (b) the anticipated benefits of the award, both for yourself and for the universities involved (c) any exceptional expertise or facilities available to you through this visit (d) how you and your department/school propose to sustain research relationships built through your visit We require a supporting statement from your home supervisor to be attached. This statement should explain benefits to you, your group, and school or department and should indicate how the research relationships built will be sustained after the visit. Please print his/her name Email address Has the receiving department or school made a firm commitment to accept Yes/No this student? We require a supporting statement from the host supervisor to be attached. Please print his/her name Email address Have you confirmed fee waiver Yes/No with the host RMP coordinator? We require a supporting statement from your home head of school or department to be attached. Please print his/her name Email address Statement from applicant I wish to apply for a Worldwide Universities Network PhD RMP Award. If successful, I undertake to observe the Award Regulations and to provide a detailed final report to the University WUN Steering Group. I agree that the University and Worldwide Universities Network may hold and process personal information in connection with this RMP and may use my name and the information relating to this proposed research visit for any publicity purposes that they deem appropriate. Signed Date