Microbiology

							                                                                                      President’s Fund for Research Visit Grants

Microbiology
          society              for      general                                                                      To support early-career members visiting another
                                                                                                                       laboratory to undertake a 1 to 3 month project


                                                                                                            APPLICATION FORM 2011
Membership no.
                                                                                                  Full scheme details available at www.sgm.ac.uk/grants/pfrv.cfm


1. Applicant details   Surname                                                                                                              For office use only

                                                                                                                                            PFRV/11
                       Forename(s)                                                               Title (Dr/Mr/Mrs/Miss/Ms)
                                                                                                                                            Date Joined
                       University
                                                                                                                                            Subscription
                                                                                                                                            Paid (2011)
                       Department
                                                                                                                                            Date application
                                                                                                                                            received
                       Address
                                                                                                                                            Host support

                                                                                                                                            Dates of Visit
                                                                         Postcode
                                                                                                                                            Other funding
                                                                                                                                            sources
                       Telephone no.                                     Email
                                                                                                                                            Date of Award

                       ACADEMIC QUALIFICATIONS                                                                                              Amount of
                       University                                        Title and Subject of Award                  Year of Award          Award

                                                                                                                                            Date Claimed

                                                                                                                                            Date Sent

                                                                                                                                            Report received



                       PRESENT POSITION
                       o PhD student               o    Postdoctoral Researcher           Date began study or took up present employment

                       o   Research Assistant      o    Lecturer                          Funding body / Employer
                                                                                          (e.g. University, MRC, Wellcome Trust etc.)
                       Other



2. Visit details       (A) VISIT LOCATION AND DATE(S)

                       Dates of proposed visit

                       Duration of visit (weeks)

                       Full address of institution where you will be making the research visit




                       (B) HOST SUPPORT

                       Name of host scientist

                       Invitation to visit host laboratory and institution received       Yes    o (provide evidence)
                                                                                          No     o

                       (C) PREVIOUS COLLABORATION (describe briefly any previous collaboration you or your supervisor has had with host or host institution)
                     (D) JUSTIFICATION FOR VISIT (describe briefly current research interests and relevance to your proposed visit)




3. Project details   (A) PROJECT TITLE (15 words maximum)


                     (B) SCIENTIFIC OBJECTIVES OF THE RESEARCH VISIT




                     (C) WORK TO BE UNDERTAKEN DURING YOUR RESEARCH VISIT (describe briefly)




                     (D) BENEFITS OF THE RESEARCH VISIT
                         What benefits will your research visit bring to the ‘home’ and ‘host’ laboratories?
4. Estimated costs         GIVE FULL COSTS AND A BRIEF DESCRIPTION OF EXPECTED EXPENSES FOR THE VISIT 1

                           Travel to host institution 2                                                                                                   £



                           Accommodation                                                                                                                  £



                           Other                                                                                                                          £
                           (may include airport transfers, visa charges, daily travel expenses, meals etc.)




                           Consumables                                                                                                                    £




                                                                                                                                  TOTAL COST              £   0
                           1
                             Receipts will be required to claim the grant
                           2
                             Only the cost of standard rail / economy or budget air travel will be allowed


                           FINANCIAL SUPPORT
                           Please give details and value of each contribution obtained or applied for from other sources, including your own department




                                                                    TOTAL AMOUNT TO BE CONTRIBUTED BY OTHER SOURCES                                       £


                                                                                                                        GRANT REQUESTED                  £


5. Supporting statement
                           TO SUPPORT THE APPLICATION AND THE DETAILS PROVIDED ABOVE
                           (to be completed by applicant’s supervisor / Head of Department / senior manager)




                           I certify that the applicant is: (please tick the appropriate box)
                           o studying for a higher degree                                              o is a graduate scientist (employed for less than 3 years in first microbiological post)
                           o has worked no more than 3 years in a post-doctoral position               o a recently appointed lecturer (employed for less than 3 years in first post)

                           Signature                                                                                                             Date

                           Name (in Block Capitals)


6. Applicant declaration
                           The rules of the scheme are available at www.sgm.ac.uk/grants/pfrv.cfm
                           I confirm that I am a member of the Society for General Microbiology who has not received a President’s Fund for Research Visit Grant in 2009 or
                           2010 and that I have read, understood and agree to abide by the rules of the scheme


                           Signature                                                                                                             Date


THREE copies of the completed form and all supporting documentation must be submitted:
by post to Grants Office, SGM, Marlborough House, Basingstoke Road, Spencers Wood, Reading RG7 1AG, UK, email to grants@sgm.ac.uk, or Fax to +44 (0)118 988 5656