Bath Institute for Mathematical Innovation and SAMBa
Undergraduate Research Internships
Application Form 2016
Please refer to the accompanying Guidelines before completing this form. Before submitting your form, please
ensure you have completed everything on the checklist.
All pages should be completed and returned by 5pm FRIDAY 22 JANUARY 2016 to imi@bath.ac.uk
Please include all relevant information on the form itself – additional papers and/or incomplete applications will
not be accepted. All applications will be acknowledged by email to Research Supervisors.
1
Title, first name and surname of Supervisor
F/M
2
Position of Supervisor
3
Full address of Supervisor’s department (the below will be the contact details for all correspondence about the application)
Tel:
Email:
4
Title, first name and surname of Student
F/M
5
Title of research
6
Brief summary of the research project (no more than 200 words)
7
Start date of project
8
Financial details – support for student
(£200 per week, maximum 10 weeks)
End date of project
a)
Please state the
number of weeks
for the project
b)
Total student
support requested
(Nb. Overheads will not be paid and research expenses are not offered except in exceptional circumstances.)
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STUDENT’S SUPPORTING INFORMATION – for completion by the student
(Nb. Please ensure you answer each question thoroughly as additional CVs are not accepted)
9
a)
Name, contact address and email
b)
Institution, degree course, year of graduation
c)
GCSE, GNVQ, A-level or Standard and Higher level results, or equivalent
d)
University exam results to date (please detail all results to date on individual modules)
e)
What are your career aspirations?
f)
Have you previously been awarded a research internship or vacation scholarship?
g)
Will this work contribute directly to your degree? (for example: is this part of your final project? Will you receive a mark
from this project which will contribute to your degree?)
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10
h)
Why would you like to be considered for a research internship and in particular why have you chosen this project and
research group?
i)
Any other information.
j)
FINAL YEAR STUDENTS ONLY: If you are a final year student intending to undertake a Taught Masters degree following the
completion of your undergraduate degree please confirm here (please note that final year students not intending to
undertake a Taught Masters degree are ineligible for the scheme).
Declaration: I accept the Conditions of Award and Reporting Requirements
Student’s signature
(may be scanned):
Date:
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TUTOR’S STATEMENT – for completion by the Student’s Academic Tutor
11
Name of student:
12
Institution:
Degree course:
13
Year of course (e.g. second year of
a three year course = 2/3)
Year of graduation:
(Nb. Final year students must be intending to undertake a taught Masters’ degree course immediately following their
undergraduate degree and should declare this in part 9j.)
14
Supporting statement from the student’s academic tutor. This should include:

How you feel the student would benefit from receiving a grant.

A comment on the student’s academic performance to date.

His/her likely final degree result or rank order in course group, or current overall mark (please ensure you indicate how
these relate to degree classifications).
15
Tutor’s name:
Position:
Tutor’s signature (may be
scanned):
Date:
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RESEARCH SUPERVISOR’S STATEMENT – to be completed by the Research Supervisor
16
a)
Are you applying for other funds for this student or project
b)
If yes, please give details and when the result is expected:
17
How many years’ experience do you have as an independent researcher?
18
Statement of the research to be carried out
(The statement should not be more than 700 words)
Yes/No:
a)
Description of the project to be carried out.
Please include title, brief background, the aims of the project and details of the investigation to be carried out and the
methods to be used. You can also include any details of funds available to support the research expenses for the project and
if any external facilities are required. Up to three recent literature references may also be given, but please do not send
reprints.
b)
The role of the student in this project
This should include what arrangements will be made to supervise the student, an approximate timetable for him/her and
what objectives you hope will be achieved in the period of the grant.
19
Key words:
20
a)
Have you previously held a LMS Undergraduate Research Bursary?
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Yes/No:
b)
21
If yes, please give the year, career track of the bursar and any use of the bursary results, for example in publications, grant
applications or further research:
Declaration: I accept the Conditions of Award, Reporting Requirements and the Data Protection Policy.
Research Supervisor’s
signature (may be scanned):
Date:
For information only, from what source did you learn about
these awards?
HEAD OF DEPARTMENT – for completion by the Research Supervisor’s Head of Department
22
Heads of Department are asked to ensure:
i.
the project and the roles of the student and supervisor are clearly described and can be supported by the facilities of
the host department;
ii. that only one application is submitted per supervisor
Name of department:
Name of Head of Department signing on behalf of the institution:
Head of Department’s
signature (may be scanned):
Date:
CHECKLIST
Before sending in this form please check that:
The Student has signed the form (10)
The Student’s Tutor has signed the form (15)
The Research Supervisor has signed the form (21)
The Head of Department has signed the form (22)
Please check carefully that all sections of the form have been completed.
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