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Tropical Agriculture Award Fund Application Form

 

Standard 6 months-plus Awards

 

 

Personal Information

Surname M/F
First Name Middle name
Permanent Address

 

 

 

 

Address for correspondence

 

 

 

 

Telephone

 

Mobile
Current Email

 

Permanent Email

(if different)

Date of Birth

 

Nationality

 

Passport No

 

 

 

 

Health

It is expected that you are in good health and take the necessary advice in relation to health precautions in your prospective country of work/project. However, if you have a medical condition that could affect your ability to work in a remote area, please attach a letter from your GP confirming that you are fit to undertake the proposed assignment

 

 

Education

Most recent first and only back to A levels

From To Name and location of institution Qualifications gained Title and content of course Full/part-time
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Languages   Please rate whether 1: fluent, 2:working knowledge or 3: basic

Language 1 2     3
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employment History

From To Organisation

(Name, address and type)

Description of post held Responsibilities Reasons for leaving
 

 

         
 

 

         
 

 

         
 

 

         
 

 

         
 

 

         

 

Please also account for any periods not covered elsewhere.

 

 

Interests

Please give details of spare time activities that are relevant to your application such as voluntary work. Also demonstrate your interest in development issues and/or your research interests. Give positions of responsibility held.

 

Activity Position
 

 

 

 

 

 

 

Project   Please expand the boxes as follows as necessary in order to give the information needed

Name of project Country Period you plan to be there
Start date Planned end date
 

 

 

 

     

 

 

Detailed description of the project (aims and objectives, expected results, region)

 

 

 

 

 

 

 

 

Description of the host/employing organization (and website if available). Please attach letters or emails confirming their willingness to host you and indicating what support they will provide

 

 

 

 

Your prospective role

 

 

 

 

 

 

Wider relevance and perceived benefits to the local community/country (with particular reference to the objectives of TAAF)

 

 

 

 

 

 

Please provide a detailed budget breakdown and total expenses. Examples of eligible costs are given in the table. Please insert additional rows as required.

 

Item

Cost

Return Airfare  
Visa Costs  
Medical costs (e.g. vaccinations/malaria prophylaxis)  
Subsistence costs  
In-country travel expenses  
Translator/Field Assistant costs  
Other (please specify)  
   

Total

 

 

Have you applied for or received any other award or grant towards funding your participation in the project? If yes, what was the total of other awards (do not include personal savings or loans)?

Please give a breakdown of other funding sources, and specify if the contribution covers a particular budget item (e.g. airfare)

 

Other funding source Indicate amount secured, what is covers and whether the application is still pending
   
   
   

 

Future Career

In what discipline are you planning your future career?

 

 

 

 

 

 

 

 

 

 

References

Please forward letters of reference from two referees (one should be your most recent employer or academic supervisor). Letters of reference may be forwarded directly by the referee by email, or by the applicant (scanned signed letters on official letterhead only). Provide details of the two referees in the box below.

 

  1 2
Name

 

   
Address

 

   
Telephone

 

   
Email

 

   
Occupation

 

   
Capacity in which known