TRAVEL GRANT APPLICATION FORM – Staff Applicants Please complete all sections of the form. Incomplete forms will be returned. Part A – To be completed by the Applicant Name and Title Staff Personnel No Institute/School Appointment held Email address Authors, title and reference of three key recent publications Purpose of travel (if attending a meeting state full title; if visiting a laboratory provide supporting documentation) Please outline the importance of this visit to your research (maximum 200 words) Nature of any presentation (provide supporting documentation including personal invitation (if relevant), state the title of a paper or poster presentation, indicate if you are the presenting author and if the paper/abstract will be published) Approved GSC 6.3.12 Destination Details of proposed travel (give details of dates and routes) If you are to be away for more than one week during term, has leave of absence been approved? Expenditure (list all estimated fares, accommodation and subsistence costs) (Note that grants are towards travel and subsistence costs only. Conference fees and travel insurance will NOT be paid from the Fund. Applicants travelling outside the UK may apply for free travel insurance under the University's own policy. Subsistence costs will be paid in accordance with University policy, (http://www.ncl.ac.uk/internal/finance/documents/expenses_manual.pdf), which stipulates that: “Costs should not normally exceed £20 for lunch or £35 for dinner for UK trips, including drinks. The cost of alcohol will only be refunded when taken with a meal – alcohol is not appropriate during working hours. Gratuities will not be refunded unless included on an itemised bill as a service charge and not as an addition by the claimant. In addition to meals, snacks and refreshments may be purchased when travelling in the UK on behalf of the University up to a maximum of £10 in a 24 hour period. This is not an allowance and expenditure must be supported by receipts”.) Is funding from any other source possible (eg. professional society, conference organisers, department or research grant)? If an application has been made elsewhere, when will you know the outcome? Statement by Applicant: I confirm that I have not previously received an award from this fund in the current academic year. Any award made will be used only for the travel indicated. Adequate evidence of expenditure will be submitted in due course. (Please do not attach receipts to this application form.) Signature Approved GSC 6.3.12 Date Part B - To be completed by the Head of Institute In Confidence Please indicate your assessment of the applicants’ research standing by selecting option i) ii) or iii) below and deleting as appropriate. The applicant is: i) a leading international/national authority ii) an established researcher whose contributions are of outstanding/high/moderate promise iii) a young researcher whose contributions are of outstanding/high/moderate promise The value to the applicant in undertaking the activity (meeting/laboratory visit./training course) for which the funds are requested would be: *very high/high/moderate/low The value to science in the applicant’s attending would be: *very high/high/moderate/low *Please delete as appropriate Other comments: Head of Institute’s signature Date Completed applications and any enquiries should be addressed to the Graduate School Office, Medical School, extension 7002. Applications should be made as far in advance as possible. Applications will be considered at these times only: 1st February, 1st May, 1st August and 1st November. Retrospective claims will not be considered. Approved GSC 6.3.12