application form - Commonwealth Scholarship Commission in the ...
application form - Commonwealth Scholarship Commission in the ...
application form - Commonwealth Scholarship Commission in the ...
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COMMONWEALTH RESIDENTIAL SCHOOL: The World <strong>in</strong> 2113<br />
8-12 August 2013, Cumberland Lodge, W<strong>in</strong>dsor Great Park, United K<strong>in</strong>gdom<br />
COMMONWEALTH SCHOLARS BURSARY APPLICATION FORM<br />
1.a) TITLE (delete as applicable)<br />
1.b) FULL NAME (underl<strong>in</strong>e surname)<br />
2. PERMANENT ADDRESS<br />
3. ADDRESS FOR CORRESPONDENCE (if different from above)<br />
4. EMAIL ADDRESS<br />
5. TELEPHONE NUMBER ╪<br />
6. FAX NUMBER ╪<br />
7. DATE OF BIRTH<br />
8. NATIONALITY(IES)<br />
9. CURRENT COURSE AND YEAR OF STUDY*<br />
10. CURRENT UNIVERSITY**<br />
* Applicants should be engaged <strong>in</strong> a course of study at an ACU member university. At <strong>the</strong> time of<br />
<strong>application</strong>, <strong>the</strong>y should ei<strong>the</strong>r be study<strong>in</strong>g for a postgraduate degree (full- or part- time) OR <strong>in</strong> <strong>the</strong><br />
f<strong>in</strong>al year of an undergraduate degree, with <strong>the</strong> expectation of mov<strong>in</strong>g to postgraduate study on<br />
completion.<br />
** A list of universities that are members of <strong>the</strong> ACU can be found at<br />
www.acu.ac.uk/membership/acu-members<br />
╪<br />
Optional
11.a) ACADEMIC RECORD <strong>in</strong> chronological order<br />
From To School/college/university<br />
Qualifications (<strong>in</strong>clud<strong>in</strong>g course<br />
title and subjects studied)<br />
11.b) EMPLOYMENT RECORD <strong>in</strong> chronological order (if any)<br />
From To Organisation Ma<strong>in</strong> role(s) and activities<br />
11.c) PUBLICATIONS <strong>in</strong> pr<strong>in</strong>t, digital or multimedia (if any)<br />
12. CURRENT OR PREVIOUS MEMBERSHIP OF OR INVOLVEMENT IN SOCIAL, CULTURAL,<br />
POLITICAL, COMMONWEALTH OR OTHER INTERNATIONAL ORGANISATIONS (if any)<br />
13. ANY OTHER ACTIVITIES THAT YOU WOULD LIKE TO MENTION
14. HAVE YOU STUDIED, WORKED, OR UNDERTAKEN ANY VISIT LONGER THAN<br />
FOURTEEN DAYS OUTSIDE YOUR HOME REGION BEFORE? (Please see section at <strong>the</strong> end<br />
of this <strong>form</strong> for def<strong>in</strong>ition of regions)<br />
If YES, please give details (maximum 100 words)<br />
15. WHY WOULD YOU LIKE TO ATTEND THE COMMONWEALTH RESIDENTIAL SCHOOL?<br />
WHAT DO YOU FEEL YOU WOULD CONTRIBUTE? (maximum 100 words)
16. THE THEME OF THIS YEAR’S COMMONWEALTH RESIDENTIAL SCHOOL IS ‘THE<br />
WORLD IN 2113’. PLEASE WRITE A SHORT CREATIVE STATEMENT (no more than 300<br />
words) ON HOW YOU FEEL THE WORLD WILL CHANGE IN THE NEXT CENTURY IN ANY<br />
AREA OF YOUR CHOICE.
16. BURSARY APPLICATION<br />
The CSC is mak<strong>in</strong>g available a number of bursaries for <strong>Commonwealth</strong> Scholars, cover<strong>in</strong>g costs of<br />
attendance at <strong>the</strong> school (accommodation, meals, and registration fees) and travel to <strong>the</strong> venue<br />
from with<strong>in</strong> <strong>the</strong> UK.<br />
PLEASE TICK THE APPROPRIATE BOX BELOW:<br />
I WISH TO APPLY FOR A COMMONWEALTH SCHOLARS BURSARY<br />
NO BURSARY REQUIRED – I WILL COVER ALL THE COSTS OF ATTENDING MYSELF<br />
17. REFEREE<br />
Name <strong>the</strong> person you are ask<strong>in</strong>g to supply a confidential reference about you. This person<br />
should be familiar with your recent academic work.<br />
NAME<br />
ADDRESS<br />
POSITION<br />
EMAIL<br />
ADDRESS<br />
18. DECLARATION BY APPLICANT<br />
I declare that <strong>the</strong> statements made <strong>in</strong> this <strong>application</strong> are, to <strong>the</strong> best of my belief, true,<br />
complete and correct.<br />
SIGNATURE<br />
DATE<br />
Please return this <strong>form</strong> when complete to:<br />
Joanne Hyde<br />
Student Engagement Officer<br />
Email: joanne.hyde@cscuk.org.uk<br />
Fax: +44 (0)20 7387 2655<br />
Post: <strong>Commonwealth</strong> <strong>Scholarship</strong> <strong>Commission</strong><br />
c/o The Association of <strong>Commonwealth</strong> Universities<br />
Woburn House<br />
20-24 Tavistock Square<br />
London WC1H 9HF<br />
UK<br />
Applications should be received at <strong>the</strong> above address by 4 April 2013. Applications received<br />
after <strong>the</strong> clos<strong>in</strong>g date will not be considered.<br />
Successful applicants will be notified by end May 2013.