The Australian Society for Microbiology

Below is the online application form. Please fill in all required details on the form and click the Submit button at the end of the page. The form details will be sent directly to our offices.

If, however, you would rather post your details to The ASM, you may download and print out this PDF document: Research Trust Application Form

Full Name:
* Must Be Entered
Date of Birth
/ /
Present position and date of appointment:
* Must Be Entered
Current institutional address:
* Must Be Entered
Telephone:
* Must Be Entered
Fax:
* Must Be Entered
Email:
* Must Be Entered
ASM membership status: (Student/Associate/MASM/FASM)
* Must Be Entered
Special Interest Group affiliation(s):
* Must Be Entered
RESEARCH PROPOSAL DETAILS : Title of proposed study (no more than 100 characters):
* Must Be Entered
Location of proposed study:
* Must Be Entered
Proposed date and duration of Fellowship:
* Must Be Entered
Name and address of: Intended Supervisor/Head of Host laboratory:
* Must Be Entered
One Referee (include telephone, fax, Email):
* Must Be Entered
Career chronology (from beginning of tertiary studies):
* Must Be Entered
Are you currently enrolled for a higher degree?		yes no
If Yes:
	Degree (PhD, MSc, etc.):
	Date of initial enrolment:
	Full-time / part-time:
	University:
	Department:
	Supervisor (s):
	Expected date of completion:
	Current support and date of termination:
If No:
	Present salary:
	Job description:
Statement by Applicant
I hereby agree, should I be awarded an ASM Research Trust Fellowship, to comply with the General Conditions of the Grant, as enunciated.
I agree:
I do not agree: