2010 Bursaries – Individual Application Form
(Please use typescript or write clearly in dark ink)
1. Personal
Details
Full Name: Age:
Address:
Postcode:
Daytime Telephone No:
Evening Telephone No:
Profession or Craft:
2. Qualifications
Please list all relevant qualifications with
dates, the institution from which you obtained them, and the grade you
received.
3. Work
Experience
Current Employer:
Address:
Postcode:
Contact Name:
Telephone No:
If self-employed, please state how many
years you have run your own business:
Previous Employment (Please list, with
dates, details of previous employment):
Professional Aims (Please indicate how you see
your career developing, and how you plan to achieve your aims):
Of what two achievements in your career to
date are you most proud of?
4. Reason
for Application
What will you use the Bursary for, if
successful in your application? (Please tick one or more of the options below,
and then complete the appropriate further questions)
Courses: (Go to question 5)
Travel or visits: (Go to question 6)
Work Experience: (Go to question 7)
Other: (Go to question 8)
5. Courses
Please give the name and address of the
educational establishment, workshop or training venue.
Title and length of course:
Start Date:
Has a place been confirmed?
How will this course benefit your career
aims?
6. Travel
or visits
Names and addresses of organisations and/or
people whom you would like to visit and the proposed length of each stay.
Have you received firm invitations?
Intended dates of travel and return:
How will these visits benefit you?
7. Work
Experience
Names and addresses of the firms,
organisations or workshops where you will be spending time, with start dates
and proposed length of stay.
Have you been accepted?
Will you be paid a salary?
How do you hope to benefit from this
experience?
8. Other
If you would like to use the bursary for any
other purpose, please describe it fully, explaining why you would like to do it
and what benefits you hope to obtain from it.
9. Amount
of Money Required
Total Required: £
Please give a broad breakdown of how the
money will be used.
Please list any other charities to which you
have applied for funding, together with the outcome of your application.
10. Declaration
I agree to use the money from the Bursary,
if granted, only for the purpose set out above.
I will provide a report to the Foundation within one year on how the
money was spent and how the Bursary helped me to achieve my goals.
Signed:
Date:
11. Sponsor’s
Endorsement
Name of Sponsor:
Address:
Postcode:
Occupation or Profession:
How long have you known the applicant?
I confirm that the information given above
by the applicant is accurate, that s/he is well deserving of a Bursary from the
Foundation, and that I will monitor his/her use of it.
Signed:
Date:
Please return this form, when completed
to:
The
Secretary
York Foundation for Conservation and Craftsmanship
Fossgate
The Merchant Adventurers' Hall
Fossgate
YO1 9XD
to arrive
before Saturday 27 March 2010.