AMERICAN PHYSIOLOGICAL SOCIETY
9650 Rockville Pike
Bethesda, MD 20814 USA
PERKINS MEMORIAL FELLOWSHIP AWARD
APPLICATION - HOST
(THE HOST MUST BE A MEMBER OF THE AMERICAN PHYSIOLOGICAL
SOCIETY)
Host______________________________________________________________________________
Institution_______________________________________________________________________
Address___________________________________________________________________________
___________________________________________________________________________
Visiting
Scientist________________________________________________________________
Duration of visit: From____________________________
To____________________________
Did you invite the applicant to visit your laboratory or did the applicant
ask to come?
______________________________________________________________________________
___________________________________________________________________________________
How will the applicant be supported (fellowship, your research funds, his
own university/sabbatical leave, other)? Indicate amount of funding from
each source:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Indicate the amount of supplement from Perkins Fund to enable the family
to accompany the applicant and participate in the life of community in
reasonable comfort:
$__________________________________________________________________________
Provide a brief summary of the research which you and the applicant
propose to carry out
___________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Has the applicant had previous experience in the this area of research?
____________________________________________________________________________________
Will he/she bring special skills and experience to you or do you regard your
proposed collaboration as a period of training for him/her?
____________________________________________________________________________________
Do you regularly have one or more foregin guest scientists in your
laboratory?
____________________________________________________________________________________
Apart from his/her own research, do you expect the applicant to
participate in teaching, association with graduate or medical students,
conduct seminars?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
How will you assist the applicant and family in gaining cultural
enrichment?
____________________________________________________________________________________
____________________________________________________________________________________
_____________________________
____________________________________________________
Date
Signature
Please do not hesitate to supply additional information which you
think will help the Perkins Fellowship Committee to reach a decision.
(Applications are due April 15 and October 15 with
notification of applicants by June 15 and December 15, respectively). For
scientific visits beginning between January 1 and June 30, the application
is due on October 15 the year before with notification by December 15. For
scientific visits beginning between July 1 and December 31, the application
is due on April 15 of the same year with notification by June 15.
|
