Application Form ASICS Study Grant

Name of applicant:

Email address:

Postal address:

Please attach a curriculum vitae, no more than 2 pages in length, including details of academic qualifications and relevant professional development activities over the past five years.

Project Title (Brief description of no more than twenty-five words in length)

Project Summary (No more than 100 words in clear, concise terms suitable for inclusion in publications. The summary should be intelligible to the lay reader and outline the significance of the project)

   

 

Name & address of employer or details of your practice

Details of Project Proposal Please provide details of your project. This proposal should be no more than two pages in length. Please include the following categories:

• Aims and expected outcomes of project • Proposed methodology • Identification of any ethical issues • Proposed timeline • Other financial support - is this project being supported by another grant or award? If yes, please provide

details including the awarding institution, the amount and the period of grant support.  

Budget Proposal Summary For administration purposes, please attach a brief budget for the project.  

 

 

Signature Date

Either scan and email your application and supporting documentation to contact@podiatry.org.nz, or post to PO Box 11542, Manners Street, Wellington 6142