Faculty of Medicine, Dentistry & Health Sciences Student Affairs Office APPLICATION FORM Postdoctoral Seeding Fellowship SCHOOL OF DENTISTRY Faculty of Medicine, Dentistry and Health Sciences LATE OR INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED CRICOS Provider Number: 00126G
IN CONFIDENCE * Please refer to instructions 1 Full Name of Applicant Title Surname Given Names 2 Current Appointment Gender (M/F) 3 Date of Appointment (Format DD MON YYYY) 4 Full Postal Address for Notification (Please advise immediately of any changes to thi dd ) Telephone (including ( ) bil ) Facsimile ( ) Email 5 Applicants may wish to select an area of research interest in the School of Dentistry available on the web at: http://www.ohcwa.uwa.edu.au/research/ or contact Professor Paul Abbott paul.v.abbott@uwa.edu.au to discuss. NAME OF SUPERVISOR AND TITLE OF RESEARCH PROJECT 6 Undergraduate Academic Qualifications (Attach academic transcripts). Year Honours Degree 7 Awards, Scholarships or Prizes 2 Postdoctoral Seeding Fellowship - School of Dentistry 2010
8 Postgraduate Qualifications Degree Year Institution where degree awarded 9 Awards, Scholarships or Prizes 10 Career Summary (include relevant positions, further training and Grants or F ll hi h ld) Year Positions held or Study Institution High quality research is a major priority for the School of Dentistry at The University of Western Australia. Our research programmes have national and international links and contribute both to our basic understanding of oral diseases and to applied aspects of their prevention and treatment. There are many research opportunities in this expanding field, both for qualified dentists and for those in the many disciplines associated with the oral health sciences and dental services. To assist you in the preparation of your application, areas of research interest and contacts in the Oral Health Sciences at UWA are available on our website at: http://www.ohcwa.uwa.edu.au/research/ Prior to submitting an application, applicants are advised to contact the relevant member of staff of the School of Dentistry to discuss the feasibility of conducting your work within the School research facilities.
11 Project Details Please provide a brief summary (non scientific) of your intended area of research. 4 Postdoctoral Seeding Fellowship - School of Dentistry 2010
12 Full project description including Aims, Background and Research Plan (Not more than two pages)
13 Benefits Please indicate the significance of undertaking your research in the School of Dentistry at The University of Western Australia and describe how your career would benefit from undertaking research in Western Australia. For example - include your career aims, benefits to the School, and commitment to Oral Health Research in Western Australia. 6 Postdoctoral Seeding Fellowship - School of Dentistry 2010
14 Publications of Applicant for Consideration of Track Record Please ensure that you list only those papers, articles or abstracts that have been published in refereed journals in the last six years (indicate clearly whether published or in press and include evidence of final acceptance by the editor). Include reviews, book chapters and conference presentations.
15 Referee Reports In-Confidence (applicant nominated) First Referee Name Address Telephone ( ) Facsimile ( ) Email Second Referee Name Address Postcode Telephone ( ) Facsimile ( ) Email Postcode 16 Signature of Applicant In signing this page, I certify that all details given in this application are correct and I agree to carry out the Fellowship in strict accordance with the current Regulations governing UWA Medical and Dental Research Awards Signature of Applicant Date 8 Postdoctoral Seeding Fellowship - School of Dentistry 2010
17 Clearance Requirements Does this project include: (a) Research involving Humans? (b) Experiments on Animals? (c) Other Clearances If Yes to (c), you will be required to sign a statement indicating your awareness of the Guidelines for Laboratory Personnel Working with Carcinogenic or Highly Toxic Chemicals? Have you done this at UWA? If no, then you must submit such a statement with your application. Guidelines are available from: http://www.safety.uwa.edu.au/policies/carcinogens,_ mutagens Enter Yes or N Enter Yes or N Enter Yes or N Enter Yes or No Please Note: This project cannot proceed until ethics clearances have been obtained (d) Ethical Implications of the Project Experiments on Animals/involving Humans 18 Checklist Applicant Name Project Title Six copies of application (one single-sided hard copy & five double-sided hard copies) Academic transcripts Completion of all Sections Yes No Written applications quoting the reference number, personal contact details, qualifications and experience, along with contact details of two referees should be sent to Director, Human Resources, The University of Western Australia, M350, 35 Stirling Highway, Crawley WA 6009 or emailed to jobs@uwa.edu.au by the closing date.
REFEREE REPORT Applicant s Details Name: Current Institution: Project Title: The Faculty of Medicine, Dentistry and Health Sciences The University of Western Australia N Block, QEII Medical Centre, NEDLANDS, WA 6009 http://www.meddent.uwa.edu.au/ Please provide an overall judgement supported by detailed comments similar to a report for an applicant seeking a University appointment. The following points are provided as a guide: 1. Has the candidate shown an originality of approach in his/her published work? 2. Please comment on the standing of the journals in which the applicant s work has appeared. 3. Please comment on the potential benefit of the proposed project to the future career development of the applicant and if possible indicate how the applicant s ability and personal qualities rate in comparison with other research. 10 Postdoctoral Seeding Fellowship - School of Dentistry 2010
Referee Details Name: Appointment: Institution Signature Please ensure that the completed report is forwarded to: The Manager (Student Affairs), Faculty of Medicine, Dentistry and Health Sciences The University of Western Australia, N Block, QEII Medical Centre, NEDLANDS, WA 6009 This report can be faxed or emailed to: Fax: (08) 9346 2369 Email: jan.dunphy@uwa.edu.au Date
REFEREE REPORT Applicant s Details Name: Current Institution: Project Title: The Faculty of Medicine, Dentistry and Health Sciences The University of Western Australia N Block, QEII Medical Centre, NEDLANDS, WA 6009 http://www.meddent.uwa.edu.au/ Please provide an overall judgement supported by detailed comments similar to a report for an applicant seeking a University appointment. The following points are provided as a guide: 1. Has the candidate shown an originality of approach in his/her published work? 2. Please comment on the standing of the journals in which the applicant s work has appeared. 3. Please comment on the potential benefit of the proposed project to the future career development of the applicant and if possible indicate how the applicant s ability and personal qualities rate in comparison with other research. H 12 Postdoctoral Seeding Fellowship - School of Dentistry 2010
Referee Details Name: Appointment: Institution Signature Please ensure that the completed report is forwarded to: The Manager (Student Affairs), Faculty of Medicine, Dentistry and Health Sciences The University of Western Australia, N Block, QEII Medical Centre, NEDLANDS, WA 6009 This report can be faxed or emailed to: Fax: (08) 9346 2369 Email: jan.dunphy@uwa.edu.au Date