Professional Documents
Culture Documents
1. Employment
a. Current employment
Job Title
Describe your roles in research, teaching, administration, medicine or other areas. Indicate the
% of your Full Time Employment (FTE) devoted to each major role. (Total 50 words).
Research
Teaching
Administration
Medicine
Other (Specify)
2. Academic qualifications
a. PhD or equivalent research degree. Only complete if you are an applicant with a PhD or
equivalent postgraduate degree.
Thesis title
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b. Clinical and higher qualifications. Only complete if you are an applicant with clinical
qualifications.
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e. Other completed research-relevant specialist/technical training
List other significant training relevant to your development as a researcher that you successfully
completed, e.g., short courses and training attachments.
3. Research Experience
b. Why do you consider yourself to be an early career researcher? Max 100 words.
1.
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2.
3.
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5.
6.
7.
8.
d. List Grants or Fellowships you have applied for in the last two years. Add more lines as
required.
e. List any Grants or Fellowships you have been awarded greater than or equal to £5,000. Add
more lines as required.
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PART C: CAREER VISION AND STRATEGY
4. Describe your career vision and personal development strategy. Max 250 words.
5. Describe your research focus and your research niche referring to your research
experience and career development plans and the potential impact on health in Africa.
Max 150 words.
6. Please give details of any gaps in your career path to date. Max 100 words
PART D: FELLOWSHIP
7. Fellowship Title
A simple title that indicates the purpose of your Fellowship. Max 25 words.
Summarise your Plan for the Fellowship in a way that non-scientists can easily understand
(“lay summary”). Max 300 words. Include any references in box 20.
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9. Fellowship Plan
a. Preparatory Period before the Placement
Activity Start to End Activities to achieve Preparatory Objectives Add rows as required
dates
.. to ..
.. to ..
.. to ..
.. to ..
.. to .. 1.
.. to .. 2.
.. to .. 3.
.. to .. 4.
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.. to .. 5.
.. to .. 6.
.. to .. 7.
.. to .. 8.
.. to .. 9.
.. to .. 10.
.. to ..
.. to ..
.. to ..
Provide an abstract including aim, methodology and expected outcomes for the small project
that you will undertake during the fellowship. Max 250 words.
Aim:
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Methodology:
Expected Outcomes:
If your fellowship will involve the use of animals or samples or data from humans, please
provide information on the ethical approval in place and/or required for your project. This
includes permission for shipping samples or data sharing. Max 100 words.
Course 1
Hosting Organisation
URL if available
What methods / techniques will you learn and how will you use those new skills later?
Course 2
Hosting Organisation
URL if available
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What methods / techniques will you learn and how will you use those new skills later?
Course 3
Hosting Organisation
URL if available
What methods / techniques will you learn and how will you use those new skills later?
If you intend to undertake other specific training during the Fellowship, including on-the-job training,
please describe it here and explain why it is important.
Conference title
URL if available
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15. Knowledge and Skills Transfer
a. How will you transfer your new knowledge and skills to your EO or more widely within
Africa? Maximum 150 words.
b. How will the scientific techniques be adopted in your EO, be clear on whether the
technology is in place at your EO or the plan to bring the technology to your EO?
Maximum 100 words.
Name of EO Institutional
Director
Sponsor’s relationship to
you (e.g., your immediate
boss, head of department)
How will your EO Academic Sponsor(s) will assist you? Max 50 words.
Name of Host
Organisation
Name of HO
Institutional Director
Name of your HO
Academic Sponsor(s)
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Explain why you have chosen this organisation as your host including why it is a Centre of
Excellence in your research area. Max 100 words
c. Career Mentor
How your Specialist or Career Mentor will assist you? Max 50 words.
19. Identify an appropriate Funder for the research question and explain why they are
appropriate. Max 80 words.
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20. Publication references
A maximum of 12 references.
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PART F: 21 Financial request: Summarise and justify your main expenditure categories. Please read the guidance information
which covers allowable and non-allowable costs. - including the maximum allowable costs. Failure to follow the guidance
correctly may result in your application being deemed ineligible for consideration
Total Amount
Cost Item Cost Item (not all these maybe Justification: Please explain how the cost was calculated
Requested
number applicable to your Fellowship) and why it is necessary to the Fellowship
(£GBP)
Indirect costs. For African institutions Maximum of 10% of preparatory period costs
Prep-6
only.
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Place-3 Settling-in allowance (£250 max)
Indirect costs. For African institutions Maximum of 10% of placement period costs
Place-10
only
Indirect costs For African institutions Maximum of 10% of follow-up period costs
Follow-Up-4
only
TOTAL
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