Apply for the Fellowship Academy

Fellowship Academy application form

1. Name

First name

Last name

2. Title

3. Email

4. Name of home institution/company

5. Home institution/company address

6. Current position

7. Please indicate at what stage of your career you see yourself at:

8. Please provide a short summary of your current research and/or research interests, and their relevance to digital health

9. Please provide details of any memberships of professional bodies

10. Please upload your research proposal

11. If you do not have a prepared research proposal, please outline in brief the research question on which you would like to focus

12. Please detail any contacts at Brunel who you have previously worked with.

13. Please upload your current CV

14. Please upload a letter of recommendation from your line manager. This should confirm your current position and details of how you will benefit from your visit to the Brunel Fellowship Academy.

15. We have limited funds to help support successful applicants with costs that would otherwise be prohibitive to participation. For example, this might apply for early career academics and more junior industry participants on lower salaries, applicants from countries with significantly lower costs of living, than the UK, for disabled applicants who require special arrangements and so on. Accommodation will be provided free of charge (not for accompanying persons) and a daily allowance for the additional costs of eating away from home of £15 will be provided. Please state here if you would require additional financial support, describing the nature and approximate costs of your requirements.

16. Will you require assistance with finding suitable accommodation?

YesNo