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Application form Scientific Research
"
(Required)
" geeft vereiste velden aan
1
Personal Info
2
Research info
3
Participants
4
Budget
5
Literature
6
Sign
7
Confirm
This application form is open from 1 august until 15 october
Currently this application form is only available in English, we are working on a dutch translation. If you want, you can fill in the fields in Dutch.
Please select the funding source you wish to apply for
(Required)
De Cock-Hadders Foundation funding for scientific research
Preferred language for correspondence
(Required)
Nederlands
English
Name
(Required)
Name
Surname
Email address
(Required)
Enter email address
Confirm email address
P-number
(Required)
Position (including source of funding)
(Required)
Start date of PhD project
(Required)
MM slash DD slash JJJJ
End date of PhD project
(Required)
MM slash DD slash JJJJ
Research group
(Primary) department
(Required)
-- Please select --
Anaesthesiology
Human Movement Sciences
Biomaterials
Biomedical Sciences of Cells & Systems
Cardiology
Cardiothoracic surgery
Centre for Dentistry and Dental Hygiene
Surgery
Dermatology
Epidemiology
Genetics
Health Sciences
Haematology
General Practice Medicine
Internal Medicine
Intensive Care Adults
Otorhinolaryngology
Clinical Pharmacy and Pharmacology
Paediatrics
Laboratory Medicine
Pulmonary Diseases
Gastroenterology and Hepatology
Medical Microbiology
Medical Oncology
Maxillo-facial surgery
Neurosurgery
Neurology
Nuclear Medical Science & Molecular Imaging
Obstetrics & Gynaecology
Ophthalmology
Orthodontics
Orthopaedics
Pathology and Medical Biology
Plastic Surgery
Psychiatry
Radiology
Radiotherapy
Rheumatology & Clinical Immunology
Rehabilitation
Urology
Biology of Ageing
Other
Name of your department
(Required)
Internal UMCG postcode
(Required)
(Short) Title of the project
(Required)
Overall objective of your PhD project
(Required)
Overall description of the project including scientific background
(Required)
Detailed work plan for the period for which financial assistance is requested
(Required)
Location and availability of research facilities and other facilities
(Required)
Main participants in the project
Mention also your supervisor(s) max 6.
Name, title and affiliation (department)
(Required)
Task(s) in the project
(Required)
Hours contribution per week
(Required)
Supervisor - Name, title and affiliation (department)
(Required)
Supervisor - Task(s) in the project
(Required)
Supervisor - Hours contribution per week
(Required)
Add extra participants
-- How many do you want to add? ---
1 extra participant
2 extra participants
3 extra participants
4 extra participants
5 extra participants
6 extra participants
7 extra participants
Name, title and affiliation (department) 3
Task(s) in the project 3
Hours contribution per week 3
Name, title and affiliation (department) 4
Task(s) in the project 4
Hours contribution per week 4
Name, title and affiliation (department) 5
Task(s) in the project 5
Hours contribution per week 5
Name, title and affiliation (department) 6
Task(s) in the project 6
Hours contribution per week 6
Name, title and affiliation (department) 7
Task(s) in the project 7
Hours contribution per week 7
Name, title and affiliation (department) 8
Task(s) in the project 8
Hours contribution per week 8
Name, title and affiliation (department) 9
Task(s) in the project 9
Hours contribution per week 9
Name, title and affiliation (department) 10
Task(s) in the project 10
Hours contribution per week 10
Budget
Overall budget for consumables, specified according to sources and years (calendar years, not academic years)
Item
(Required)
Price
(Required)
Detailed specification
(Required)
Item
Price
Detailed specification
Item
Price
Detailed specification
Item
Price
Detailed specification
Item
Price
Detailed specification
Item
Price
Detailed specification
Item
Price
Detailed specification
Item
Price
Detailed specification
Item
Price
Detailed specification
Item
Price
Detailed specification
Literature: recent publications from the applicant relevant for the present project (submitted, in press, published, conference presentations)
(Required)
Literature from your research group: relevant for the present application and not given in the previous box (max. 10*)
(Required)
Other relevant publications
Have you applied for a grant from the De Cock-Hadders Foundation in the last four years?
(Required)
No
Yes
Title of the project(s) + year of application
If you have applied for more than 1 project, please fill in al the projects where you applied to. Each project on a new line.
Was it awarded?
-- MAKE A CHOICE --
No
Yes
Name applicant
(Required)
Date
(Required)
MM slash DD slash JJJJ
Applicant's signature
(Required)
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Name of supervisor
(Required)
Date
(Required)
MM slash DD slash JJJJ
Signature, preferably by a letter of approval
(Required)
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Max. bestandsgrootte: 64 MB, Max. aantal bestanden: 1.
* As an alternative to an electronic signature from your supervisor, you can include a copy of a letter signed by your (primary) supervisor in which (s)he states that (s)he has read your application and has approved the content. Please upload the copy to the box above, before the Hora Finita statement.
Include a print screen or other copy of your Hora Finita Dashboard showing registration and progress of your project
(Required)
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Selecteer bestanden
Max. bestandsgrootte: 64 MB, Max. aantal bestanden: 1.
Terms and conditions
(Required)
I have completed this form truthfully and agree to the terms and conditions.
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Submitting your request is final. Uploading may take a while, so please be patient and wait untill your application is uploaded successfully
Email
Dit veld is bedoeld voor validatiedoeleinden en moet niet worden gewijzigd.