FORM STC-2012-01
STELLENBOSCH UNIVERSITY
FACULTY OF HEALTH SCIENCES
SCIENTIFIC TRAVEL & PUBLICATION INCENTIVE FUND
SCIENTIFIC TRAVEL: CONFERENCE APPLICATION FORM (STC-2012-01)
(a) Before this form is filled in, the regulations of the SCIENTIFIC TRAVEL AND PUBLICATION
INCENTIVE FUND should first be read and the most recent list of tariffs referred to.
(b) This application should be completed ELECTRONICALLY.
(c) The following supporting documents or copies of these documents should be attached
to the application as correspondingly marked appendices:
Appendix A:
The official announcement, advertisement or invitation of the meeting.
Appendix B:
The programme of the meeting. (If the programme is not yet available, this
should be mentioned in Appendix B and the programme should immediately
be forwarded to the relevant official after receipt.)
Appendix C:
Written proof of the registration fees required (not proof of payment).
Appendix D:
A summary of approximately half an A4 page of the congress
contribution(s) (eg. abstract) and proof of acceptance of the contribution.
(If the proof of acceptance is not yet available, this should be indicated on
the checklist and should immediately be submitted upon receipt.)
Appendix E:
A numbered list of all papers, with complete references, of the previous
3 years (2009 – present) (i) at international professional conferences, (ii) at
national professional conferences and (iii) at other meetings (but not popular
meetings). The cases for which financial support from SU has been obtained
should be indicated with an asterisk beside the numbers. If no papers have
been presented, this should also be indicated.
Appendix F:
A numbered list of all publications, with complete references, of the
previous 3 years (2009 – present) in the category of (i) journal articles, (ii)
the published proceedings of professional congresses, (iii) specialist books,
(iv) chapters in books, (v) research reports and (vi) others (not popular). If no
documents have been published, this should also be indicated.
Appendix G:
A written quotation from an approved travel agency in respect of the
cheapest air-travel tariff. Such quotation should apply to the ACTUAL
number of days of THE MEETING (even if additional travelling/visits are
undertaken with financing from other sources).
Appendix H:
The official SU itinerary form, completed correctly – Appendix H (optional
for this application, but required by Finances prior to claiming funds).
(d) There are four calls during the year, closing 1 March, 1 June, 1 September, and
1 December annually.
(e) ALL levels of staff, with the exception of Executive Heads of Department, are required to
obtain a written recommendation from their divisional/departmental head prior to submitting
their application to the Research Development and Support Division (Tygerberg). In the case
of postgraduate students a recommendation from the supervisor (promoter) will suffice.
APPLICATIONS SHOULD BE SUBMITTED BEFORE A CONFERENCE TAKES PLACE.
NO EX POST FACTO APPLICATIONS ARE CONSIDERED.
CLAIMS AGAINST ALLOCATED FUNDING NEED TO BE PROCESSED WITHIN 60 DAYS OF
RETURN FROM A SCIENTIFIC VISIT.
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STELLENBOSCH UNIVERSITY
FACULTY OF HEALTH SCIENCES
SCIENTIFIC TRAVEL & PUBLICATION INCENTIVE FUND
SCIENTIFIC TRAVEL: CONFERENCE APPLICATION FORM (STC-2012-01)
CHECKLIST:
National or international conference application
NAME: ………………………………………………………………………….
REQUIREMENTS
YES
NO
IF NO, PLEASE EXPLAIN
The OFFICIAL announcement, advert
or invitation to the meeting
The programme to the meeting
(if available at this time)
Written proof of registration fees
required
Half A4 page summary of your
congress contribution
Proof of acceptance of abstract
(Acceptance of abstract does not need
to be submitted with this application if
not available, but would be required
before a grant is awarded)
A numbered list of all conference
papers with complete references of
the previous 3 years (2009 – present)
A numbered list of all publications
with complete references of the
previous 3 years (2009 – present)
A written quotation from an official
travel agency
Completed application form to be sent to Sasley Beukes, Research Development and Support
Division (RDSD), Room 5007, 5th Floor, Teaching Block, Faculty of Health Sciences, Tygerberg
Campus.
Enquiries: Sasley Beukes (021 938 9051; [email protected])
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MARK WITH AN “X” WHERE APPLICABLE
1. DETAILS OF APPLICANT
TITLE
INITIALS
SURNAME
POSITION/RANK
DIVISION
DEPARTMENT
YEARS OF
SERVICE AT SU
FULL-TIME
SU
ESTABLISHMENT
JOINT
PAWC
PART-TIME
MRC
OTHER
(Specify)
UT NUMBER
TEL (WORK)
CELL
E-MAIL
WILL THIS WORK LEAD TO A
HIGHER QUALIFICATION?
YES
(Specify)
NO
Do you undertake to submit a report within 3 MONTHS of the conference?
Do you undertake to submit an article to an accredited journal within 6 MONTHS of
the conference?
2. DETAILS OF CONFERENCE
OFFICIAL NAME
PLACE
DURATION
NO. OF
DAYS
TO
DD/MM/YYYY
DD/MM/YYYY
NATURE AND AIM OF CONFERENCE AND CONNECTION WITH FIELD OF STUDY
INVOLVEMENT IN CONFERENCE:
INVITED
NO. OF
SPEAKER
APPEARANCES
FROM
SPEAKER
SPEAKER
OTHER
(PAPER)
(POSTER)
(SPECIFY)
TITLE OF PAPER/POSTER
3
AUTHORS (Underline name of presenting author)
ETHICS
APPROVAL
REQUIRED?
YES / NO*
ETHICS
APPROVAL
NUMBER
Expiry date
(MM/YYYY)
*IF NO, BRIEFLY
MOTIVATE
COMPLETE THE BUDGET REQUEST RELEVANT TO THIS APPLICATION ONLY
3. ESTIMATED MINIMUM TOTAL COST
TRAVEL COSTS (as per SU Travel policy)
AIR TRAVEL
RAND
AIR TICKET
TRANSPORT TO AND FROM AIRPORTS
OTHER
ACCOMMODATION
SUBSISTENCE
day(s) @
R
per day
day(s) @
R
per day
REGISTRATION FEES
OTHER (Specify)
TOTAL
OTHER FINANCIAL SUPPORT FOR ATTENDANCE OF CONFERENCE
WHAT APPLICATION IS BEING MADE FOR
(Specify source and amount in each case)
WHAT HAS ALREADY BEEN ALLOCATED
(Specify source and amount in each case)
ARE YOUR SUPPORTED BY A GRANT IN WHICH CONFERENCE TRAVEL IS ALLOWED AND
BUDGETED FOR? (Specify source and amount in each case)
AMOUNT(S) AWARDED FROM FUND FOR SCIENTIFIC
TRAVEL FOR CONGRESS ATTENDANCE RECEIVED
DURING THE PREVIOUS CALENDAR YEAR
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NATIONAL
INTERNATIONAL
I DECLARE THAT THE ABOVE DETAILS ARE CORRECT AND THAT, IF STELLENBOSCH
UNIVERSITY MAKES A CONTRIBUTION, I WILL COMPLY WITH ALL THE CONDITIONS
RELATED TO SUCH SUPPORT.
……………………………….………….
SIGNATURE OF APPLICANT
………………………
DATE
CONFIDENTIAL RECOMMENDATION FROM MANAGER – DIVISIONAL HEAD OR DIRECTOR
OF CENTRE. (Please state clearly whether or not the application is supported). If the applicant is
the executive Head of Department or Institute, s/he should indicate this below.
Please tick one:
Strongly supported

Supported
Not supported


Motivation (optional):
………………………………………………………………………………………………………………….
NAME AND RANK OF MANAGER
……………………………………………………..
SIGNATURE OF MANAGER
……………………………
DATE
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