Internship Application

Please indicate which internship your are applying for:

First name:

Last name:

Address:

Country from which you are applying:

Preferred email:

Please confirm your email address by re-entering it:

Phone number or skype handle:

Highest qualification:

Institution highest qualification was obtained from:

Year it was obtained:

Current degree or position:

Institution currently studying or working in:

Current research/activities at applicant institution (paragraph):

Name of advisor / mentor / manager:

Advisor/Mentor/Manager's contact details:

Name of an additional referee #1:

Contact details for referee #1:

Name of additional referee #2:

Contact details for referee #2:

Honours and awards:

Relevant bioinformatics workshops/meetings attended:

Publications peer reviewed:

Non-peer reviewed outputs (e.g. meeting posters):

State why the internship is relevant and timely:

Planned contribution of skills gained from visit to improving bioinformatics activities at the applicant institution and across H3Africa:

List your relevant bioinformatics experience:

List your relevant alternate scientific experience:

How will the internship enhance your current experience and personal development?

Research activities proposed for the internship:

Relevant skills/experience the host has to supervise these activities:

Which H3ABioNet node are you associated with?

Host institution:

Host country:

Host person (mentor/supervisor in host institution):

Proposed date of visit (start):

Proposed date of visit (end):

Travel costs:

Accommodation costs:

Subsistence costs:

Additional training costs (e.g. course attendance fees, bench fees, insurance):

Are there any other anticipated costs?

Anticipated costs:

Anticipated costs are associated with:

Letter of motivation from your supervisor:

Letter of support from proposed host: