Main details

Expedition Title:

Expedition Leader:

Expedition website (if available):

Summary of the main objects of the expedition:

Country:

Location of Expedition – nearest settlement or Lat/Long (please attach a location map - see note 3)

Expedition contact name and address for all correspondence:

Expedition mobile telephone contact number:

Expedition contact e-mail for all correspondence:

Dates

Departure and return dates:

Number of weeks in field:

People

Total Number of members:

Number of scientists:

Number of members under 18:

Number of mountaineers:

Number of other personnel:

Number of assistants:

Costs

Total estimated cost:

Travel to area:

Freight:

Other travel costs:

Field equipment:

Scientific equipment:

Food:

Fuel:

Insurance:

Administration:

Report preparation and publication:

Contingencies:

Income

Total grant income raised to date:

Other grant making bodies approached:

Contribution to costs by expedition members (show total and cost per member):

Other funds raised:

Consultation

Whom have you consulted about your plans?

Is political or other permission required and if so has an application been made for a permit?

Bank details

Please provide bank account details for the account to receive the grant.

Account Name:

Account Number:

Sort Code:

Bank:

Contacts

Leader's address:

UK contact name during expedition (if known):

Leader's e-mail:

UK contact e-mail during expedition (if known):

Leader's mobile telephone and direct line:

UK contact mobile telephone and direct line (if known):

Referrees

First referee name:

Second referee name:

First referee address:

Second referee address:

First referee contact phone number:

Second referee contact phone number:

First referee contact e-mail:

Second referee contact e-mail:

Expedition information

Expedition member experience, qualifications and ages:

Summary account of proposed objectives (a detailed expedition plan with maps can also be submitted):

Outline of logistic plan and operational methods:

Safety: State what plans and experience you have to cope in the event of an accident or illness during your expedition:

Risk assessment: Please confirm that a risk assessment, preferably by a third party, of the proposed expedition has taken place, in line with the measures outlined in BS 8848, the British Standard for organising and managing visits, fieldwork, expeditions and adventurous activities outside the UK. If reference has not been made to BS 8848, please confirm that all the necessary health and safety measures comprised in a proper risk assessment have been considered as part and parcel of the preparations for the expedition. Please attach your risk assessment as a file after the text box below.

Environmental Impact: please outline any significant environmental, social and cultural impacts that your expedition might have, and give details of the strategies that you will adopt to minimise and mitigate these:

For expeditions with a significant scientific focus:

• What are the objectives of your scientific research? (maximum 100 words).
• Describe the field research work to be done, paying special attention to methodology, and the novelty/new knowledge to be generated from the expedition. If more than one project is to be carried out, explain how different projects relate to each other (maximum 250 words).
• Please indicate the scientific outputs (contribution to theses, journal articles, conference or other presentations, online reports for example) intended to result from the work, and the plan for delivering these.

Confirmation

I confirm that I have undertaken a full safety risk assessment of the activities of the proposed expedition.

Signature of leader (print name):

Date: