APPLICATION FORM SYLVIA NAISH FELLOWSHIPS AND SCHOLARSHIPS 2015‐16 VISITING POSITION APPLIED FOR (please indicate as appropriate) Research Fellowship → Date doctorate awarded (month/year) Post‐Doctoral Fellowship → Date doctorate awarded (month/year) Scholarship (Postgraduate) → Year of study 2nd 3rd CONTACT DETAILS OF APPLICANT (please complete in block capitals) Surname First Name(s) Title Correspondence address Telephone Email PERIOD FOR WHICH FELLOWSHIP/SCHOLARSHIP IS SOUGHT (between 1 September 2015 and 30 June 2016) From (day/month/year) To (day/month/year) TITLE OF RESEARCH PROJECT TO BE PURSUED DURING THE FELLOWSHIP/SCHOLARSHIP (please attach a proposal of not more than 1,500 words) REFEREES (please give the names and contact details of two academic referees and arrange for them to send their references by the closing date direct to [email protected]; references must be specific to the fellowship and project applied for) Name Name Address Address Email Email CHECKLIST AND DECLARATION I have read and accept the terms on which the fellowship/scholarship for which I’m applying is offered. Attached to this application are: Research Proposal Outline Statement Publications List Curriculum Vitae Signature of Applicant Date Please send your completed application form together with supplementary documentation to reach Jane Lewin at the IMLR, University of London, Senate House, Malet Street, London WC1E 7HU, by 30 April 2015. Applications by email (preferred) should be sent to [email protected] and include ‘Naish Visiting Fellowship Application 2015‐16’ in the subject line. Please ensure that files conform to the requested length and that they are correctly named.