Application form - The Soulsby Foundation

You may apply for a 2018 Soulsby Fellowship between 1 October 2017 and midnight (GMT) on 31December 2017.

Please apply online using the form below or download the form using these links:

Download and print the application form (Microsoft Word format) ↓

Download and print the application form (Adobe PDF format) ↓

Name of applicant
Title*
- Dr.
- Prof.
- Mrs.
- Miss.
- Mr.
- Other.
First name*
Last name*
Job title*
Contact details
Full postal address*
Email*
Enter Email Confirm Email
Telephone number (with extension if relevant):
Mobile phone number*
Affiliated Institution
Name of Affiliated Institution*
Full postal address*
Web URL*
Relationship with the Affiliated Institution*
Please provide details - employee/registered student/other (please specify)
Name of supervisor/laboratory head/department chair*
Email address*
Telephone number*
Qualifications and professional experience
Qualifications*
Please include institutions and dates – degrees, diplomas, post graduate experience
Professional experience*
Add further lines using the + symbol to the right
Dates Employer/Organization Position
Publications and presentations*
Please list up to FIVE of your key publications or presentations relevant to this application
Project
Proposed Project*
Please describe (in no more than 700 words) how you propose to use the Soulsby Fellowship, how the experience will enhance your career and how the project will promote and impact the concept of "One Health" internationally. Please indicate any relevant contacts you have already established but do NOT try to attach any evidence. This evidence may be requested by the Trustees if your application is short-listed.
Personal Statement*
Please describe (in no more than 200 words) why your life experiences make you a good candidate for a Soulsby Fellowship
Budget
Proposed total budget
Add further lines using the + symbol to the right
Item Amount
Total Budget (UK£)*
Amount requested from the Soulsby Foundation (UK£)*
Please note:

The Fellowship award will be made in UK £ sterling. Allowable expenses may include: economy travel (airfares and any transfers), visas, insurance and accommodation.
Source(s) of further funds (UK£)*
Please list potential sources of further or matching funds, indicating whether a decision has been made and/or whether the award is contingent on your succeeding with this application. Add further lines using the + symbol to the right.
Organization Amount requested Expected decision date Notes
References

Please give below the name and contact details of two people who may be asked to act as referees for you. They will be expected to have authoritative and personal knowledge of your professional achievements / competencies. If you are short-listed, referees may be contacted directly by the Soulsby Foundation.
Referee 1
Name*
In what capacity, and over what period of time, has this individual known you?*
Phone*
Email address*
Referee 2
Name*
In what capacity, and over what period of time, has this individual known you?*
Phone*
Email address*
Please complete your application and submit it no later than midnight (GMT) on Sunday 31 December 2017

Before submitting this application, please read the guidelines to make sure you are a qualified applicant.
Sharing your information*
Please tick this box to confirm you accept that the Soulsby Foundation will hold the information you submit and may share this information solely for the purposes of assisting you with your enquiry or application.
- Yes I understand and agree to the statement above
Please tick this box

Facebook

Google+

Twitter

Name of applicant

Contact details

Affiliated Institution

Qualifications and professional experience

Project

Budget

References

Referee 1

Referee 2