Trevor Platt Scholarship Application Form

Trevor Platt Memorial Scholarship Application Form

"*" indicates required fields

Applicant Details

Full name (first, middle, last)*

Date of birth*

DD/MM/YYYY

Gender

Male

Female

Other

Primary email*

Secondary email

You may provide another email address where we can contact you

City*

The name of the city where you currently reside

Country*

The name of the country where you currently reside

Nationality*

Current Professional / Academic Affiliation

University/Institute Name*

Name of the University/Institute where you are currently studying/working.

Institute Country*

University Degrees*

List all degrees held along with the name of the University and the year you graduated (or expect to graduate, if currently enrolled) e.g., B.Sc, Delaware University, 2012; PhD, Rome University, 2023.

Current position*

Your current position (e.g. student, researcher, post-doc etc.) or the degree you are currently doing.

Research area*

Your current area of research

Curriculum Vitae*

Please upload a brief curriculum vitae (1-2 pages max., I MB max.) summarizing your professional and research experience and interests. Save your CV using the format: Lastname-Firstname-Platt-Scholarship.pdf (or doc/docx). Please do NOT include photographs or certificates etc.

Accepted file types: doc, docx, pdf, Max. file size: 5 MB.

Supervisor at Parent Institution

Supervisor Full Name*

Supervisor Email*

Supervisor Mailing Address

Supervisor Telephone Number

Recommendation from Your Own Supervisor*

Please attach signed Letter of Recommendation from your own Supervisor. Save this letter using the format: YourLastname-SupervisorLastname-recommendation.pdf (or doc/docx).

Accepted file types: doc, docx, pdf, Max. file size: 5 MB.

Supervisor at Host Institution

Host Supervisor Full Name*

Host Supervisor Email

Host Supervisor Mailing Address

Host Supervisor Telephone

Recommendation from Your Host Supervisor*

Please attach signed Letter of Recommendation from your host Supervisor. Save this letter using the format: YourLastname-HostSupervisorLastname-recommendation.pdf (or doc/docx).

Accepted file types: doc, docx, pdf, Max. file size: 5 MB.

Proposed Research/Training

Title of Proposed Research or Training*

Expected dates*

Proposed start and end dates for training/research at host institute

Description of Training/Research*

Attach a document with specific details of all aspects of training /research to be carried out at the host institution (2 pages max.) Include a detailed budget of anticipated expenses, specifying the currency, (e.g., return flight, visa, travel/health insurance, accommodation, food and incidentals). If the visit is estimated to costs more than US $5,000, please indicate how the additional expenses will be covered (e.g., by host institute, own institute, other grants etc.). Save file using format: Your-lastname-firstname-description-date.pdf (or .doc or docx).

Accepted file types: doc, docx, pdf, Max. file size: 5 MB.

Relevance*

Relevance of the proposed training/research to programmes/research at your own institution and how training/research will contribute to capacity building at your own institution.

Personal Statement*

Please provide a brief personal statement (one to two paragraphs) outlining your goals, experience, attributes, and academic achievements, and how they relate to the proposed research/training. You may also demonstrate how this relates to any of Trevor Platt’s research.

Certify*

I certify that all the information in this form is true and correct at the time of writing.

Yes

Comments

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