Western S Innovation Fund Application

VISITING UNIVERSITY SCHOLAR PROGRAM WESTERN INTERNATIONAL GRANTS COMPETITION

IMPORTANT INFORMATION AND REGULATIONS:

If you wish to receive a preliminary administrative review by Western International, email your application to Melissa Franco at [email protected] before the Dean’s deadline date.

1. Submit your completed nomination form to your Dean for approval. CV’s, quotes and other supporting documents can either be copied into the last page of your application or emailed as separate attachments. Hard copy or emailed submissions, with signature approval, will be accepted by Western International.

2. Submit your completed nomination form with all required signature approvals in one PDF format to [email protected] CV’s, quotes and other supporting documents can either be copied into the last page of your application or emailed as separate attachments. Please note that hard copy submissions are not required, but will also be accepted.

REQUIRE ASSISTANCE? This program’s competition is administered by Melissa Franco on behalf of Western International (E-mail: [email protected] ext. 86409).

DETAILS OF NOMINATING FACULTY Host Faculty: Host Contact Name: E-mail: Telephone: Department or School: Building and room number:

PARTICULARS OF NOMINATED SCHOLAR Name: Academic Title: Department: Home Institution: City and Country:

NOTE: Please enclose a full updated Curriculum Vitae of the nominee REQUESTED FUNDS

Amount Requested from VUSP: $ (Maximum $3000 to be matched and must be in Canadian currency) SIGNATURES Signature approval confirms support for this nomination and agreement that the terms and conditions as outlined in Western’s policies, as well as, the Internal Grants and VUSP Guidelines have been met.

DEAN’S SIGNATURE

Signature, Dean of Faculty Date PROPOSED PROGRAM OF THE VISIT

1. Proposed Period of Visit (< 4 months): From To

2. Will the nominated scholar be staying in residence at Western through the Visiting Faculty Housing Program during the summer months?

3. Has the nominated scholar had previous links with Western? Please list dates/occasions of previous visits, if any:

4. Please indicate and describe the proposed activities to be undertaken by nominee during the visit:

Teaching:

Seminars:

Research:

Off Campus Visits:

Other:

5. Provide a brief description of the nominated scholar’s specialty/outstanding attainments, prospective benefits to your faculty and to Western (250 words max.).

6. Provide a brief description of the publicity plan to be used in conjunction with the visit.

BUDGET SUMMARY AND JUSTIFICATION:

List all sources and amounts of Revenue Source Amount revenue for this visit in the section Visiting University Scholar Program $ below. Refer to Program Specific Guidelines for ineligible expenses. Faculty $ Department $ Other (list) $

(must be in Canadian currency) Total $

BUDGET JUSTIFICATION An adequate budget justification is required. To avoid arbitrary decisions on the appropriate level of funding, detailed explanations of costs and quotes must be provided (must be in Canadian currency).

CV, QUOTES AND OTHER SUPPORTING DOCUMENTS: On this page, please either insert or copy/paste the Visiting Scholar’s full CV, required quotes and/or any other additional documents, such as letters of support.