APPLICATION FOR
VISITING INTERNATIONAL SCIENTIST AWARD
Please note:
1.
Successful applicants will be required to submit a written report to the Centre Director at the end of the visit outlining the details and
impact the visit had on your research group (a template will be provided).
2.
Applications must be received by [email protected] by 31 July, 2015.
* indicates mandatory fields
Applicant (Research Team Leader)
Title *
First Name *
Last Name *
Telephone *
Email *
Research Team Name:*
Proposed International Visitor
Title *
Position Title *
Country *
First Name *
Last Name *
Org/Institute *
Telephone *
Email *
Brief description of the visiting scientist’s background, including the specific skills that will be shared with
your research group * (max 1500 characters – approx 200 words)
Please note: For any research group wishing to invite and support more than one visitor, please add the details
of the additional visitor below.
Page 1 of 3
Beneficiaries
Please list other personnel/Graham Centre members that will benefit from this scientist’s visit *
NAME
AFFILIATION
CSU
NSW DPI
Other
CSU
NSW DPI
Other
CSU
NSW DPI
Other
CSU
NSW DPI
Other
CSU
NSW DPI
Other
CSU
NSW DPI
Other
CSU
NSW DPI
Other
Alignment with Graham Centre Research Pathways
Which pathway is the proposed visit most closely aligned with?
Proposed Itinerary
Expected arrival date:
Expected Departure Date:
Proposed activities to provide training with Graham Centre members *
(max 1100 characters – approx 150 words)
A)
Additional funding which will be used to support the visit (personal/industry/grants) *
(max 280 characters – approx 50 words)
B)
Linkages being supported by this visit *
(max 280 characters – approx 50 words)
Page 2 of 3
Proposed Budget
Please provide brief details of the proposed budget below:
Item:
$ Amount:*
TOTAL
0.00
$
Declaration
In making this application I declare that:
•
I have read, understood and agree to the information and conditions described in the Visiting International Scientist
Award Guidelines
•
To the best of my knowledge, all information provided in this application is true and correct and no information is false or
misleading
•
I have the agreement of all parties identified in the proposal to include their details within this application
I agree *
Name *
Date *
Clear Form
Save Form
Print Form
Submit Form
If you experience difficulties submitting your application, please use the Save Form button, save a
copy of the file to your computer and send it as an email attachment to [email protected]
Page 3 of 3