Perkins vacation scholarships application form

Title*
First Name (s)*
Surname*
Contact Phone Number*
Postal Address*
Postcode*
Date of Birth*

MonthDayYear
Date
Email Address*
example@example.com
University*
Degree for which you are currently enrolled*
Present Course year*
Have you previously been awarded a Vacation Scholarship?*
If yes, please describe the project and Funding body*
ACADEMIC RECORD
Please attach your academic record to date, including details of Courses taken (eg Genetics 101); year of course (eg 2020) and result obtained (eg Pass/Credit)
Please attach your academic record*

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Laboratory in which you wish to conduct this project*
Period over which you will be conducting the project*
From*
To*
Supervisor's name*
Supervisor's phone*
Supervisor's email*
example@example.com
I have discussed the project with my proposed supervisor.*

YesNo
How will this Scholarship further your career?*
PROJECT OVERVIEW

Not more than 1,500 words
Please provide a brief description of the project, including an introduction to the area of research, the aims of the project, an outline of the protocol and techniques to be used in the project, your career aims and how the Scholarship will further your career.
Project Title*
Project description*

0/1500
Include any figures or graphs here

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APPLICANT'S SIGNATURE*

Clear
DATE*

MonthDayYear
Date
The signatures of the Applicant indicates submission of the proposed project and agreement to provide a Final Report and give a seminar at the conclusion of the period over which the Vacation Scholarship was held.
Should be Empty:

ACADEMIC RECORD

PROJECT OVERVIEW