<p> The AUSTRALIAN NATIONAL UNIVERSITY The Research School of Physics and Engineering College of Physical and Mathematical Sciences</p><p>Chennupati and Vidya Jagadish Endowment Fund Visiting Fellowship/Scholarship Award</p><p>Application Form</p><p>APPLICANT DETAILS: Name of Applicant </p><p>Type of Visiting Student or Visiting Researcher Application (please select an option)</p><p>Institution</p><p>Date of Birth</p><p>Gender</p><p>Address</p><p>Telephone</p><p>E-mail Address</p><p>PROPOSED HOST SUPERVISOR/COLLABORATOR Please include the name, department and email address of the host supervisor or collaborator that you intend to work with at the Research School of Physics and Engineering.</p><p>ABSTRACT Please provide a brief summary of the research collaboration that you would be developing with the host academic and his research group at the Research</p><p>1 School of Physics and Engineering.</p><p>RESEARCH TO DATE Briefly describe the project/research you/or the group have done to date, including details of any funders and/or collaborators (in 250 words or less).</p><p>HOW IMPORTANT WILL THIS AWARD BE TO YOU? Briefly describe how important this experience and opportunity will be for your career development and research career in physics. (in 250 words or less).</p><p>HOW DO YOU SEE THIS RESEARCH OPPORTUNITY ASSISTING YOUR ABILITY TO INFLUENCE THE ADVANCEMENT OF PHYSICS IN YOUR HOME INSTITUTION AND/OR HOME COUNTRY? Please provide a description of how this Award will help you to advance the quality of physics research in your home institution and/or home country upon your return. (in 250 words or less).</p><p>AWARDS/ACHIEVEMENTS TO DATE Please list your achievements to date.</p><p>2 PROPOSED LENGTH OF STAY? Please state the proposed length of stay. </p><p>PROPOSED TIMELINE? Please provide a brief timeline on the research activity intended for proposed research collaboration/project.</p><p>PROPOSED AMOUNT OF FUNDING SOUGHT? Please provide a brief budget, other sources of funds and funds sought from Chennupati and Vidya Jagadish Endowment Fund. Proposed amount should be in Australian dollars. </p><p>Applications should be submitted made to: Ms Julie Arnold Research School of Physics and Engineering E: [email protected] T: +61 2 612 50020</p><p>3</p>