Butterfield Awards for UK-Japan collaboration in medical research and public health practice

Application form

*please print out this page.
Name/title of applicant:
Contact details:
Name of applicant's institution/professional base:
Names and contact details of two professional referees:
(please attach references separately)

Name and contact details of partner/host in Japan/UK:
(please attach evidence of host's readiness to facilitate exchange and collaboration)

Field of research:

Outline of project/exchange/collaboration:
(attach detailed proposal separately)
When will the project take place? Who will participate? What facilities will be provided by the host/partner?
What is the importance of this field of research at this time for UK/Japan?
How far is this project breaking new ground?
What are the significant planned outcomes? How will these be assessed?
How will the continuity of the project be guaranteed in the future?


(Outline of project continued)
Total budget for the project and amount requested from the Great Britain Sasakawa Foundation
(please send detailed budget separately):
For which specific costs are you requesting support from the Great Britain Sasakawa Foundation?

What other sources of financial support are anticipated? (Please give amounts where appropriate)

Confirmed:

Approached:

Signature & date:

Thank you. Please email this form to
or send it to:
The Great Britain Sasakawa Foundation, Dilke House, 1 Malet Street, London WC1E 7JN
Tel 020 7436 9042
Website: http://www.gbsf.org.uk

The deadline for applications is the end of September for awards to be made in the early part of the following year. On receipt of this form we will confirm whether your application will be considered for an award.

NB The acceptance of a grant application does not imply any obligation on the part of the Great Britain Sasakawa Foundation and applicants should not make any commitments in anticipation of an award.