IOCCG Platt Scholarship Application Form

"*" indicates required fields

Applicant Details

Full name (first, last)*

Date of birth*

YYYY/MM/DD

Gender

Male

Female

Other

Primary email*

Secondary email

You may provide another email address where we can contact you

City of Residence*

The name of the city where you currently reside

Country of Residence*

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 your highest degree attained along with the name of the University and the year you graduated, or expect to graduate if currently enrolled (e.g. PhD, Rome University, 2025).

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-CV.pdf. Please do NOT include photographs or certificates etc.

Accepted file types: pdf, Max. file size: 2 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.

Accepted file types: pdf, Max. file size: 2 MB.

Supervisor at Host Institution

Name of Host Institution*

Host Supervisor Full Name*

Host Supervisor Email*

Host Supervisor Mailing Address*

Host Supervisor Telephone

Recommendation from Your Host Supervisor*

Please attach a signed Letter of Recommendation from your host supervisor. Save this letter using the format: YourLastname-HostSupervisorLastname-recommendation.pdf.

Accepted file types: pdf, Max. file size: 2 MB.

Proposed Research/Training

For which of the following are you applying:*

Title of Proposal*

Proposed Start Date*

An estimate of the start date for the proposed training/research at host institute

Proposed End Date*

An estimate of the end date for the proposed training/research at host institute

Proposal Description*

Attach a document with specific details of your proposal to conduct research OR training 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 USD $5,000, indicate how the additional expenses will be covered (e.g., by host institute, own institute, other grants etc.). Save file using format: Yourlastname-firstname-Platt-Scholarship-description.pdf.

Accepted file types: pdf, Max. file size: 2 MB.

Relevance*

Relevance of the proposal to your home institution, including contributions to capacity building at your home institution. You may also demonstrate how the proposal relates to any of Trevor Platt’s research and IOCCG objectives.

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 proposal.

Certify*

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

Yes

Phone

This field is for validation purposes and should be left unchanged.