Home Educational Fellowship Application Form Please complete the online form below. To complete your application, your Head of Department must also complete and submit Form B. *Title *First Name *Surname *IAP Reference Number *Present Post *Institution where award will be held *Address of Institution *Name of individual(s) to be visited *Description of the educational aspects 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 *Start date of visit *Finish date of visit *Length of visit *Travel cost *Travel date *Travel method *Travel class *Subsistence cost *Number of days subsistence *Laboratory expenses *Laboratory expense details *Total amount requested *Name and Email address of current Head of Department who will complete and submit Form B *Declaration I understand that my data will be stored by the BDIAP and I may be contacted in the future by the BDIAP on matters relating to this application and/or my membership. This data will be stored in accordance with the BDIAP's data privacy policies and will not be released to third parties. I may request that my data is deleted at any time using the data deletion request form in the data privacy policies section of the website, however, I understand that my data is stored as a contractual necessity of my application/membership of the BDIAP so that if I ask for my data to be deleted this will also mean that I am cancelling my membership and/or withdrawing my application.