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* 1. Personal Information

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* 2. Career/Research Break

Please provide dates and reasons for your career/research break.

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* 3. Proposal

Title of the proposal for bursary activities.

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* 5. Host organisation

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* 6. Proposal Dates

Date

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* 7. Bursary duration

Duration of the bursary (up to six months). Please enter the number of months.

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* 8. Support amount

Amount of support requested (up to £2,500).

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* 9. Submission year

Proposed year for submission of application.

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* 10. Supporting Documents

PDF, DOC, DOCX file types only.
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* 11. Supporting Documents

PDF, DOC, DOCX file types only.
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* 12. Supporting Documents

PDF, DOC, DOCX file types only.
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