APPLICATION FORM

(sections B, C and D combined in 1000 words; max 2 A4; Dutch or English)

Applicant(s) of the LHSC pilot project (main applicants from FSW; one coordinator; collaboration with minimum one other institute)

Full Name *

E-mail address *

Faculty and Institute *

Participating researchers / professionals (minimum one external organisation, preferably a societal partner from Leiden)

Full Name *

E-mail address *

Organisation (faculty, institute, department) *

Do you want to register another person?

Full Name

E-mail address

Organisation (faculty, institute, department)

Do you want to register another person?

Full Name

E-mail address

Organisation (faculty, institute, department)

A. Background, problem and aim of the project
(max. 150 words; how does this project contribute to the mission of the LHSC?; which theme(s) of the LHSC does this project address?) *

B. Project plan with description of the activities and expected results
(methodology; expected results; clear description of desired impact (both academic and societal); how will the project or collaboration develop after the funding stops?) *

C. Proposed timeline
(planning: starting date; taking into account the max. 18 months duration of the project.) *

D. Description of the funding and how it will be used
(personnel costs, e.g. hiring student assistant; material expenses) *