Vacation Scholarship Application Form | Society for Reproduction and Fertility

Title *

First Name *

Last Name *

Date of Birth *

University and Course Details

Please provide details of the university or college where you are currently enrolled as a student.

University/College *

Department *

Your term-time address *

Telephone number: *

Email Address - will be used for all correspondence *

Year study commenced *

Current year of study *

Degree subject and type *

Courses completed and results *

Where possible, please list individual module scores and overall year grades

Out of term details

Home address *

Telephone *

Email Address *

Project Details

Project Title *

Laboratory and Project Address *

Project background *

(Max 200 words)

Project aims *

(Max 200 words )

Project experimental materials and methods *

(Max 300 words )

Reasons for undertaking the project (must be completed by the student) *

Maximum 350 words

Period of support sought *

Proposed Start Date *

Referee and Department Contacts

The Referee should be the student's academic tutor or director of studies who can give an informed opinion on the student’s performance to date, and their suitability for a placement. The SRF will contact your referee to ensure that they support your application. Failure to provide a reference before the Committee meets to consider applications may lead to your application being disqualified. Please contact your referee ahead of the application deadline to ensure they are willing and able to provide a reference in time.

Referee Title *

Referee First Name *

Referee Last Name *

Referee's Job Title *

Referee Email Address *

Supervisor's First Name *

Your Supervisor must be a paid up SRF member. We will contact your Supervisor to ensure they support your application.

Supervisor's Last Name *

Supervisor's Position *

Supervisor Email Address *

Head of College/School/Department Title *

The SRF will contact your Head of College/School/Department to confirm that a) they consent to this research project being carried out in their department. b) this project does not constitute any part of the normal degree course of the student

Head of College/School/Department First Name *

Head of College/School/Department Last Name *

Head of College/School/Department Position *

Head of College/School/Department Email *

Finance Officer Title *

The SRF will contact the College/School/Department Finance Office to confirm that they accept the terms of this award

Finance Officer First Name *

Finance Officer Last Name *

Finance Officer Email *

Confirmation letter from the host University laboratory confirming that they will host the applicant. *

Maximum upload size: 52.43MB

Timeline of proposed work – uploaded as a file (ie Ghantt Chart) *

Maximum upload size: 52.43MB