PhD in Work Bursary Application Form

Consent for storing submitted data *

Yes, I give permission to store and process my data

Name *

Membership number *

Duration of IPEM membership (years) *

PERSONAL DETAILS will be taken from your existing membership record (including home address, telephone number, mobile number and home email address). Please ensure this information is up to date by logging in via MyIPEM.

EMPLOYMENT DETAILS (including job title, department, work address, work telephone number and work email address) will be taken from your existing membership record. Please ensure this information is up to date by logging in via MyIPEM.

Manager's name *

Manager's job title

Manager's telephone no.

Manager's email *

	Details of proposed research department
University/institution
Department
Address line 1
Address line 2
Address line 3
City
County
Country
Postcode
E-mail address (admin)
Supervisor's name
Supervisor's job title
Supervisor's telephone no.
Supervisor's email

Proposed start date *

Duration (months) *

Lay abstract (max. 250 words). Please briefly describe the research project in simple terms understandable by a general audience. The lay abstract of the funded project will be used in communications including on the IPEM website and will be included in the annual report. Applicants are responsible for ensuring the content is suitable for publication. *

How is your proposal relevant to IPEM? (max. 300 words). Explain how this application will have an impact and contribute to achieving IPEM's mission, vision, values and strategic objectives which can be found on our website. *

Aims, objectives and hypothesis (max. 250 words). Please summarise the key aims and objectives of your project and provide a concise statement of the research hypothesis, if applicable. *

Scientific background (max. 600 words). Please provide a technical summary of background information and research in support of the application. Address the innovative aspects of the project and clinical need that will be met. *

Work plan (max. 1000 words). Please outline the proposed programme of work. Include clear work packages, milestones and a summary of the general research design and methodology, and for clinical and applied research describe the analysis. *

Impact (max. 300 words). Describe the impact of this project, with particular reference to a potential group of individuals, entire population(s) and the scientific community, and/or commercial benefit. *

Further development (max. 300 words). Provide evidence of the quality of the research and training environment, including how the training experience will contribute to the student's future career development. *

Supervisor's statement as to the nature of the scientific training to be provided (max. 300 words)

Facilities (max. 300 words). What facilities are available to support the applicant during the planned work? Demonstrate that these are sufficient to complete the intended research degree project. *

Degree fees Provide a year by year breakdown of the fees that the IPEM bursary would cover (e.g. registration, tuition/exam fees, bench fees, etc.). *

	Included (yes/no)	Reason if answer is no
1. A full CV
2. A short CV and letter of support from the applicant's proposed supervisor(s).
3. A letter from the applicant's line manager confirming support for the application and project.
4. A work plan describing how employment and study will be combined.

Attachment 1

Attachment 2

Attachment 3

Attachment 4 *