AFFIX PASSPORT SIZE PHOTO HERE UNIVERSITY OF MINES AND TECHNOLOGY, TARKWA

Click or tap here to enter text. DEPARTMENT

APPLICATION FOR GHANA CHAMBER OF MINES (GCM) - TERTIARY EDUCATION FUND (TEF)

RESEARCH GRANT FOR UMaT POSTGRADUATE STUDENTS (2023/2024 ACADEMIC YEAR)

Please Complete all the Sections in the Form. Use “N/A” for fields that do not apply to you. Note that incomplete applications will not be processed

SECTION A – APPLICANT’S BACKGROUND INFORMATION

1. Full Name (as registered in the University) Surname: Click or tap here to enter text. Other Name(s): Click or tap here to enter text.
2. Date of Birth (DD-MM-YYYY) Click or tap to enter a date.	3. Gender ☐ Male ☐ Female	4. Index No. Click or tap here to enter text.
5. Home Town (This is where you hail/come from): Region:
6. Marital Status: ☐ Single ☐ Married ☐ Divorced ☐ Widowed
7. School Term Address (where you reside when school is in session. Provide details on your hall of residence, hostel, rented accommodation or your home address if you are living at home): Click or tap here to enter text.	8. Permanent Home Address (where you normally reside. Do not provide a post office box number alone but a full address): Click or tap here to enter text. Village/Town/City: Click or tap here to enter text. Region: Click or tap here to enter text.
9. Phone Number: Click or tap here to enter text.
10. E-mail Address: Click or tap here to enter text.
11. Address to which correspondence regarding this application should be sent (if different from permanent home address): Click or tap here to enter text.
12. Programme of Study: Click or tap here to enter text. 13. Current Year of Study: Click or tap here to enter text. 14. Year of study for which Grant is being sought: Click or tap here to enter text.	15. WA/CWA 1st Year 2nd Year 3rd Year Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.
16. Do you have any disability? ☐ Yes ☐ No If yes, please specify: Click or tap here to enter text.
17. Have you ever been charged and/or convicted of any criminal offence? ☐ Yes ☐ No If yes, please state the charge/conviction and elaborate on the circumstances and the outcome (Use an extra sheet if required). Click or tap here to enter text.
18. Outline any Leadership, Influence, Relationship-Building and Shared Learning Abilities: Click or tap here to enter text.

SECTION B – DETAILS OF PROPOSAL

B-1. Summary
1. Clearly State the Full Title of Thesis (maximum 20 words) Keep the title of the thesis short and simple, but informative.
2. Is your intended research project interdisciplinary? ☐ Yes ☐ No If yes, indicate the various disciplines: Click or tap here to enter text.
3. Proposed Thematic Links (Keywords) Provide 3-5 keywords relevant to your research project. Click or tap here to enter text.
4. Research Concept (maximum 250 words) Give a short summary of the proposed thesis, sufficiently informative for other professionals who are not necessarily in your field of expertise to appreciate.
5. Research Gap and Contribution to Knowledge (maximum 100 words) Clearly outline the problems in the mining industry that your research would address?
6. Proposed Budget State the estimated total amount being requested in USD. Click or tap here to enter text.
B-2. Relevance / Motivation
7. Background of the Research Area (maximum 300 words) Detail the current state of knowledge in your research area, and the need for your research.
8. Objectives (maximum 150 words) Clearly state the objectives of your research (in bullets).
9. Activities and Methodology (maximum 200 words) How will you conduct your research? Describe the activities you propose to undertake with the research funds.
10. Current Resources / Facilities (maximum 100 words) List the items and equipment that you would need for your research and indicate those that are already available.
11. Ethical and Environmental Implications (maximum 100 words) Outline the ethical and environmental impact of your research. For further clarification, contact ORIC (Room No 112 at the Administration; oric@umat.edu.gh or 0200439013/0312292534).
12. Impact of Research on Academia-Industry Relation (maximum 200 words) Describe the impact of your research on the individual, the department and the University, the Ghana Chamber of Mines, as well as the community at local, national and international levels.
13. Dissemination of Research Findings Indicate how you will disseminate your findings to the scientific world aside your thesis. ☐ Conference presentation ☐ Paper publication ☐ Other (specify): Click or tap here to enter text.
14. Estimated Budget in USD (Complete the attached Form). Provide the financial effectiveness of your research - the link between the budget and activities, with justification. In the case of PhD candidates requesting for funding for more than one year, the budget should be presented in yearly basis.
15. Timelines/Work schedule/workplan/milestone (Complete the attached Form) Provide timelines based on a 12-month work schedule which shows the duration and timing of the activities described in the proposal. In the case of PhD candidates, the workplan may extend beyond one year.
16. Attach Support Letter(s) from Industry Advisor(s)
17. Attach Support Letter(s) from Thesis Supervisor(s)
18. Declaration: I do hereby declare that all the information given above is true.
Signature of Applicant: Date:

NOTE: All Completed Forms should be sent to: gcmtef-pg@umat.edu.gh