EXTERNAL FUNDING NOMINATION FORM

ExPRESSION OF INTEREST Form for EARLY CAREER Funding Commencing in 2023
APPLICANT TO COMPLETE (Please use 12-point, Times New Roman font with single spacing)
Name and title of applicant
What is the title and/or category of funding are you nominating for?
Date PhD Awarded (date conferred). 
Applicants Department/School                     
Applicant Email Address
Proposal Title – short descriptive title – (no more than 20 words)
       
Project Summary – no more than 150 words and no more than 3 references                    
                                                                                     
Name of Proposed Mentor/Supervisor who is willing to host your research
NB:  Mentors/Supervisor must be members of La Trobe Faculty and in your Department/School
Supplementary Information:
Will this research require animal or human ethics approval?
Yes☐                No☐
Will this research involve a clinical trial?
Yes☐                No☐
Will this research involve the use of genetically modified organisms (GMOs)
Yes☐                No☐
Are there any significant facilities and/or resources required for the proposed research that are located outside of La Trobe University (if known).
Yes☐                No☐  (If yes, please list facilities or resources and their location)
               

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