Registration Form

CSL Fellowships Registration Form

Please review the instructions at How to Apply before completing this online registration form. Need help or assistance? Please email Centenary.Fellowships@csl.com.au for any assistance with submitting your application. Fields with an asterisk (*) are mandatory

Candidate Details

Full Name (as shown on evidence of permanent residence)

Title

Current Position Title & Department

Phone Number

Proposed Fellowship Commencement Date (must be on or after 1st January 2024)

Postal Address

City/Suburb

State/Region

Postcode/Zipcode and Country

Are you an Australian citizen? (Applicants must either be current Australian citizens, hold permanent Australian residency or be a 444 visa holder at the time of application.)

Date PhD was Awarded

Sponsoring Organisation

Official Name

ABN

Sponsor Details

Title

Full Name

Current Position Title & Department

Phone

Research Grants Office Contact Person

(If your institution has a Research Grants Office that supports and tracks grant applications, please provide details below and we will forward correspondence about your application, and any grant payments, to it.)

Title

Full Name

Phone

Reference 1

Title

Full Name

Phone

Reference 2

Title

Full Name

Phone

Project Details

Scientific Title of Project

Short Title of Project

Ethics approval has been sought and/or approval obtained from Institutional Ethics Committees, for any work involving human or animal experimentation (Ethics approval must be in place before research can start as per standard processes at the host Institute. It is not required to be in place for the application process.)

Summary of proposed research (written for a lay audience, no more than 200 words)

How did you find out about the CSL Centenary Fellowships?

If Other, please specify

Application submitted successfully

Thank you for submitting your application