Walter Hines Page Scholarships

Chautauqua Bell Tower Scholarships

  • Application form 2016-17

This application form must be typed and accompanied by:

  • A research proposal (1000 words – please see ‘Notes for applicants’)
  • A recent professional reference/testimonial
  • Four passport sized photographs bearing the applicant’s name on the back.

Please note: If successful, youwill be required to provide a medical certificate or GP’s letter demonstrating your fitness to undertake astrenuous research trip.

Which scholarship/s are you applying for (please tick one or both):

Walter Hines Page

Chautauqua Bell Tower

Your union/educational association:

Personal information

Title:First name:Last name:

Date of birth:

Nationality:

Home address:

Telephone:

Personal email:

Professional information

School address:

School telephone:

School email:

Current position:

Subjects taught:

Teaching experience in the last five years:

Education and qualifications gained:

Further information

Have you ever lived in, or visited America? If so, for how long, and for what purpose?

Do you have experience of public speaking? If so, in what capacity?

Can you confirm that your local authority and/or governing body will grant you the necessary leave of absence (Chautauqua: 2-6 weeks between late June and late August 2016, Walter Hines Page: 2 weeks between mid-October 2016 and mid-May 2017 OR mid-October 2017 and mid-May 2018)?

Are you in a position to pay the remaining travelling and in-country living expenses?

Where did you hear about the scholarship?

Referee

Name:

Relationship to you:

Address:

Email:

Telephone:

Declaration

I declare that the information given above is correct:

Signature: Date:

PLEASE RETURN TO YOUR UNION OR ASSOCIATION BY MONDAY 18 JANUARY 2016.

IF YOU ARE ONLY APPLYING FOR A CHAUTAUQUA BELL TOWER SCHOLARSHIP, PLEASE RETURN TO THE ENGLISH-SPEAKING UNION, DARTMOUTH HOUSE, 37 CHARLES STREET, LONDON W1J 5ED. IF YOU ARE APPLYING TO BOTH SCHOLARSHIPS, PLEASE RETURN TO YOUR UNION/ASSOCIATION.

SHORTLISTED APPLICANTS WILL BE INVITED TO INTERVIEW IN LONDON IN MARCH 2016.