The ECTS/Servier research fellowship application form is in two parts (1) a downloadable document and (2) an online form:

1. The application document: ECTS/Servier application document [.doc]
Please save this document to your local computer, complete it and submit electronically with the online form below.

This document must include financial details, a full description of the research project, list of current grants and CVs of applicant and sponsor.

2. The online form below

Please read the accompanying notes [PDF] carefully before completing the application and ensure that all the necessary information is included.

Please provide list of grants and CV, for both applicant and sponsor, in accompanying document.

Applicant's Details

Title*

Dr Mr Mrs Miss Ms Professor

Name:

*

Surname:

*

Appointment

*

Institution

*

Email:

*

Confirm Email

*

Sponsor - Head of host laboratory

Name:

*

Appointment

*

Institution

*

Email:

*

Confirm Email

*

Institution accommodating the project

Institution

*

Address:

*

City:

*

Country:

*

Postcode:

*

Telephone:

Fax:

Project

Title:

*

Abstract of research:

(in no more than 150 words)

Please use plain text only, substitute Greek letters etc for the relevant word (eg beta). If symbols are essential include the abstract within the accompanying word document.

*

Keyword 1:

Keyword 2:

Keyword 3:

Keyword 4:

Keyword 5:

Keyword 6:

Total cost of application

Total cost:

EUR *

Proposed starting date

Start date:

*

Project approved by

Head of Department

Name:

*

Email:

*

Confirm Email

*

Administrative Authority

Name

*

Email:

*

Confirm Email

*

Appointment

*

Address:

*

Name and details of Administrative Officer (if different from above)

Name

Email:

Confirm Email

Appointment

Address:

Details of facilities available and other support

Facilities:

(in no more than 150 words)

*

Has this or a related application currently or previously been submitted elsewhere?

Yes (if yes give details below)      No

Details:

Details

Is the proposed project likely to lead to patentable or commercially applicable data or apparatus?

Yes (if yes give details below)     No   

Details:

Details

Does your project include any procedure which involves patients or normal human subjects?

Yes     No   

If YES, has Ethical Committee approval been obtained?

Yes (if yes attach file below)     No    N/A   

Approval document:

This file must be either a pdf [.pdf] or word document [.doc] - no other formats are accepted. If you have several files please amalgamate into one file.

Does the project involve any procedure which requires the use of experimental animals?

Yes     No   

If YES, have the relevant licenses been obtained?

Yes     No    N/A   

If YES, do the licenses cover the full term of the grant?

Yes     No   

If YES, has the work been approved by the Ethical Review process?

Yes (if yes attach file below)     No    N/A   

Approval document:

This file must be either a pdf [.pdf] file or word document [.doc] - no other formats are accepted. If you have several files please amalgamate into one file.

Please use the field below to select the accompanying (completed) Word document [.doc] on your local computer. When you submit the application this file will be uploaded along with your form and forwarded to the reviewers.

Accompanying document:

*

(Please check the size and format of your document - only files under 3MB will be accepted. Please ensure that you save word files in a format that is fully compatible with word 97-2003. Files saved in .docx format will not be accepted.)

Where did you hear about ECTS grants and awards?

Please Select... Broadcast Email Colleagues Advert in Nature Website Conference exhibition stand Banner ad Ad on Google   

Other (please specifiy)

Please press Submit when you have completed the form.

Press reset to clear the form and start again.

When submitted please wait while the file is uploaded, this is dependent upon the size of the file and the speed of your connection. When complete you will receive an acknowledgement.