Name *

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Last

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Email *

Email

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Please provide details of published papers. *

Please include for each: Full Name and Title
Department / Establishment
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Click or drag files to this area to upload. You can upload up to 3 files.

Please upload your CV as a Word or pdf file

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University / Institute / Hospital details administering the grant, if approved:

University / Institute / Hospital Name *

University / Institute / Hospital administering the grant, if approved:Address *

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Title of project: *

Department accommodating the project (if applicable):

Abstract (Word limit: 250 words, in BMJ format) *

Summary of research (for a lay audience) (Word limit: 500 words) *

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Proposed Start Date *

Proposed End Date *

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Financial Support Requested For

(May not be for three years)

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Year 1 *

Year 2

Year 3

Total Support *

Please give details of the nature of support requested : (Word limit: 4,000 words) *

Are you applying elsewhere for support for work that is part of the proposal?

If so, to which organisation(s) and when is a decision expected?

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Is ethical committee approval required? *

Yes
No

Terms & Conditions *

I have read the terms and conditions of the British Fluoridation Society Research Grant and, if my application is successful, I agree to abide by them. I shall be actively engaged in and have day-to-day control of the project.

Main Applicants Signature *

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Name *

Date *

Please enclose the following: *

Full details of the proposed fellowship
Detailed justification of the support requested
Details of any institution or background support available to the project

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This application should be submitted by the Head of Department and the officer who would be responsible for administering any grant that may be awarded. Both should sign the following:

I confirm that I have read this application and that, if granted, the work will be accommodated and administered in the Department in accordance with the British Fluoridation Society’s Terms and Conditions. All necessary licences and approvals have been or are being sought.

Signature of Head of Line Manager: *

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Department *

Date *

I confirm that the Institution will administer the grant, if awarded, and that the staff grading and salaries quoted are correct and in accordance with normal practice of the Institution.

Signature of Officer responsible for administering grant *

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Post Held *

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Institution/Hospital: *

Date *

Fellowship Application Form

Borrow Fellowship Application Form

University / Institute / Hospital details administering the grant, if approved:

Financial Support Requested For

Are you applying elsewhere for support for work that is part of the proposal?

This application should be submitted by the Head of Department and the officer who would be responsible for administering any grant that may be awarded. Both should sign the following:

I confirm that the Institution will administer the grant, if awarded, and that the staff grading and salaries quoted are correct and in accordance with normal practice of the Institution.