Hornby Trust Scholarship Application Form

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The British Council, 49 Alfred House Gardens, Colombo 03, Sri Lanka

Please complete all parts of this form in black ink or typescript.

Part A: Personal Details

Family name:.

(as on passport)

Other names:.

MrMrsMissMsDrOtherMaleFemale

Title:Sex:

Nationality:.Date of birth:.

Address for correspondence in home country:Emergency contact:

Name, address and telephone number of next of

kin or person in your home country who should be

contacted in the event of an emergency (please

state relationship).

Address:
Telephone number (landline):
Mobile phone:
Email address: / Address:
Telephone number (landline):
Mobile phone:
Email address:

Note: Please tell your ‘Emergency contact’ that you are giving us their name and contact details.

Name and address ofpresent employer:.

Please provide brief details of your post, grade and main responsibilities:
Part B: Academic Background

Please list all academic qualifications obtained since completing your secondary education, stating the institutions attended, the main subjects of study and when the main courses started and finished. Please indicate with an asterisk (*) those courses which were entirely or mainly English medium – i.e. where the language of instruction or supervision was English:

Qualification (including class or level) / Institution / Subject / From / To

Note: Please attach photocopies of all relevant academic certificates or transcripts, with accompanying translations into English, if they are written in another language.

Part C: Professional Background

Please list all positions held since completing your tertiary education:

Position / Organisation/Institution / From / To
Part D: Study in the UK

Successful candidates will be awarded a scholarship to study an MA in Teaching English to Speakers of Other Languages (TESOL) in the UK.

We are currently carrying out the selection process for a new university to host Hornby scholars. The final decision on the chosen university will be made in April 2014. Candidates will be informed of the university and the course options available to them before they finally accept the scholarship.

Have you ever studied in the UK?YesNo

If so, were you in receipt of a British Government-or British institution-funded award or scholarship? Please give full details.

Part E : Referees

Please attach letters from two referees (both of whom should be professional or academic) in support of your application. Please provide details of the two referees below. If you are unable to attach letters from your referees, please ask them to write to us as soon as possible.

Note:Please tell your referees that you are giving us their name and contact details.

(a)First Referee

Title and name.

Position.

Address.

How long have you known this referee?.

What is his/her professional relationship to you?

(b)Second Referee

Title and name.

Position.

Address.

How long have you known this referee?.

What is his/her professional relationship to you?

Part F: Your professional background

Please describe your current English teaching duties and responsibilities. Please describe any teacher training you have delivered, and explain whether this was part of PRESET or INSET programmes or both. (Approximately 250 words total.)

Part G: Supporting Statement

Finally, please state in not more than 1,000 words (approx 250 words per section):

(a)why you wish to study for an ELT Mastersin the UK,

(b)what professional experience, skills and interests you would bring to your studies

(c)how you think you would benefit in terms of career and personal development from obtaining this qualification once you have returned to your home country, and

(d)what benefit will your training bring to your place of employment.

(a) Why do you wish to study for an ELT Masters in the UK?
(b) What professional experience, skills and interests would you bring to your studies?
(c) How do you think you would benefit in terms of career and personal development from obtaining this qualification once you have returned to your home country?
(d) What benefit will your training bring to your place of employment?
Part H:Data Protection Notice

The British Council will use the information that you are providing to help administer and evaluate your Scholarship application, and if successful to administer the award. Where necessary we may also pass this information to third parties that need the information to help us with this purpose.

If you are granted an award we will be contacting your academic supervisor(s) in the UK to obtain information on your progress and in particular to find out about exam results. Your supervisor will be asked to complete a confidential final report at the end of your award.

As part of our administering and evaluating your scholarship the British Council office in your home country will hold your information, where it will be handled in accordance with our data protection policy. If a third party in your country is involved with your award it may also be passed to them. Examples might be the British Embassy or High Commission or local sponsors.

You have the right to ask for a copy of the information we hold on you, for which we may charge a small fee, and the right to ask us to correct any inaccuracies in that information. If you do want to see a copy of your information, please contact the Data Protection Team by email at or send in your request to, the Data Protection Team, The British Council, 10 SpringGardens, London, SW1A 2BN or your local British Council Office.

Signature: / Date:
FOR OFFICIAL BRITISH COUNCIL USE ONLY
TO BE COMPLETED BY OVERSEAS BRITISH COUNCIL OFFICE

Other documents attached to this form (please tick):

Photograph

Photocopies of academic certificates
(and translations, if relevant)

Letters from two referees

IELTS Test Report Form

Declaration of Health

Other (please specify)

Could you also provide the following information

1) Contact details of the British Council person in the local office responsible for the Hornby Scholars:

2) Charging instruction / WBS for the Scholar’s return flight (only applicable if the Scholar has not been provided with a return flight and you would like ProgrammesProjects to book the return flight on your behalf).