Trevor Platt Scholarship Application Form

Trevor Platt Memorial Scholarship Application Form

Applicant Details
Full name (first, middle, last)*
Date of birth*
DD/MM/YYYY
Gender
- Male
- Female
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: 1 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: 1 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: 1 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: 1 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
- No
Name
This field is for validation purposes and should be left unchanged.

Trevor Platt Memorial Scholarship Application Form

Applicant Details

Current Professional / Academic Affiliation

Supervisor at Parent Institution

Supervisor at Host Institution

Proposed Research/Training