INTERNATIONAL ACTIVITIES

Australian Academy of Science Scientific visits

Summary sheet

(All fields must be completed)

1. Program: Sub-program

2. Proposed country

3. Address details

Title
First Name
Last Name
Position
Organisation
Other
Application sector
Department
Street Address
Suburb
State Postcode Country

4. Contact details

Phone (work) Phone (mobile)
Fax
Email

5. Date of birth

Day / Month / Year

6. Name and address of main host

Title
First Name
Last Name
Position
Organisation
Department
Street Address
Suburb
State Postcode
Country
Email
Phone (work) Phone (mobile)

7. Brief title of proposal

8. Total amount of funding requested from the Academy based on:

  • China, Japan, Korea and Taiwan: maximum return airfare contribution is AUD$2,000
  • China: maximum living allowance contribution to non-CAS institute is AUD $2,100 (up to 14 days at AUD$150 per day)
  • Taiwan: maximum living allowance contribution is AUD $5,600 (up to 28 days at AUD$200 per day)
Total $

9. Duration of visit

Number of days

10. Proposed dates of arrival and departure:

  • China, Japan, Korea and Taiwan: Travel must commence from 1 April 2010 and be completed by 31 December 2010.
Arrival
(Day / Month / Year)		 Departure
(Day / Month / Year)

General

1. Please select your field of science from the following list

2. Please select the most relevant National Research Priority that your research falls under

3. Where did you find out about the Academy's program?