Home Educational fellowship application form Please complete the online form below and then ask your head of department to complete Form B which can be downloaded by clicking here and ask the HOD email that form to Sam Kiely, BDIAP Administrator *First Name *Last Name *Professional address *Postcode *Phone / Mobile *Email *Present Position *Institution where the award would be held *Address of institution *Name of the individual(s) to be visited *Description of the educational aspect to be studied *Please state briefly why you have chosen this centre *Please describe how this visit will benefit your education and those in your home department *Starting date of visit *Finishing date of visit *Length of visit (months) *Travel cost (£) *Travel date *Travel method *Travel class *Subsistence cost (£) *Number of days subsistence *Laboratory expenses (£) Laboratory expenses details *Total amount requested (£) *Name and address of current head of department who will complete form B and send it in *Declaration and Privacy Policy I have read and agree to the declaration and privacy policy