THE NOVO NORDISK UK RESEARCH FELLOWSHIP - Download as DOC by PKGLpkTb

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									The Novo Nordisk
UK Research Foundation
Charity registration number: 1056410

Research Fellowship
Summary application form


Reg. No (for office use only)


(Handwritten forms will NOT be accepted, please use font size 10)


1.       Name of applicant:

         Date   of birth:
         Date   of full GMC registration:
         Date   of MRCP:
         Date   & type of additional degrees:

         Current appointment:


         Place of work:
         (with complete address)




         Contact telephone number
         Contact email address

         Name, address, telephone, email of department:
         (where Fellow will be employed)




         Name and position of project supervisor:



         Please attach a current CV of project supervisor (max. 2 pages
         including only 5 recent important publications) and a full CV
         required for proposed Research Fellow (if known at this stage).




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2.       Please summarise the project on this page only, do not include any
         references. Include: title, aims, background, plan, relevance to diabetes.
         Please include a power calculation.




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3.       Please give (max 250 words) a summary of your project for ‘lay
         persons’.




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This part should be filled in by the Supervisor

4.       Supervision:
         Please submit a full description of the supervision and training
         provided.




5.       Please state the Research Fellow’s clinical training and/or obligations
         in the department in full.




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6.       Consumables. Please give full breakdown of consumables
         with costings.




7.       If the budget for consumables exceeds the allowance as detailed in
         the Guidelines, a full description of finance for the outstanding
         amount must be provided here:




8.       All applications are peer reviewed. Please can you recommend a
         reviewer for your application who has not published with you or
         worked in the same institutions as you for 5 years.

         (Name, address, tel, e-mail)




9.       I confirm that I have read the Novo Nordisk UK Research
         Fellowships Regulations Conditions and Guidelines for completion
         of this application form.

         (photocopies will not be accepted, original signatures required)

         Signature of Applicant                                   Date



         Signature of Supervisor                                  Date


10.      Please indicate where you saw the Fellowships advertised?




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