Young Darwin Scholarship Application 2017
Please read the background information about the Young Darwin Scholarship before you complete the application form.
Closing date for applications is Friday 23 June 2017. We will let you know by the beginning of July if your application has been successful.
Completed applications should be sentto Sue Redding, FSC Head Office, Preston Montford, Shrewsbury, SY4 1HW email
About You
First name / Last nameMale/female / M/F / Date of birth / ____/____/____
School
Contact details
Address Line 1Address line 2
Address line 3
Town/City / Post code
mobile / You can text me yes/no / Y/N
email / You can email me yes/no / Y/N
What A Level (or similar) subjects are you studying or do you intend to study?
What year are you currently in? Year 11 or Year 12
Please give details of any societies or clubs that you have joined
Funding
If you are awarded a Young Darwin Scholarship the FSC will support you in a variety of ways over the coming years. This will start with 85% funding of the Young Darwin Summer residential this year. This means that you will only have to make a contribution of £45 towards this 5 day residential.
Dates of the Young Darwin Residential 2017
The residential will take place from 19 August to 23August at FSC Preston Montford in Shropshire near Shrewsbury the birthplace of Charles Darwin.
These dates have been specially selected so as not to clash with GCSE or AS Level results
Why should yoube awarded a Young Darwin Scholarship?
Please tell us about yourself, your interest in the natural world, why you think you should be awarded a scholarship and how you feel you would benefit from the scholarship
(please do not attach a CV or additional information just use this form)
To be completed by your parent/guardian or carer
Ifyour son or daughter is awarded a Young Darwin Scholarship is there anything that we need to know to make sure they get the most from the award? This information will not affect our selection process but will help us make sure your child receives the correct support so that they get the most out of the programme.
Has your son/daughter gota physical or mental medical conditionor is he/she taking regular medication? Yes/No If yes please give details
Is your son/daughter registered disabled? Yes/NoIf yes please give details
Please provide any further information that you feel we need to know overleaf
Parent/guardian or carer’s name and contact details
Title / First name / Last namePhone / Mobile
I understand that my son/daughter is applying for a Young DarwinScholarship which begins witha residential programme 19-23 August 2017. I agree that information provided by myself and my child can be used by Field Studies Council for the purposes of running and evaluating the summer programme.
Signed...... Date......
To be completed by you
I (full name) ...... wish to apply for a Young Darwin Scholarship.
I understand that if I am awarded a Young Darwin Scholarship I shall have to pay a
Contribution of £45 towards the summer residential.
I confirm that I am able to attend the residential from 19 to 23August 2017
I agree that the information I have provided can be used by Field Studies Council for the purposes of running and evaluating the programme.
Signed ...... Date ......
Field Studies Council
Head Office, Preston Montford, Shrewsbury, Shropshire SY4 1HW
Tel: (01743) 852100 Fax: (01743) 852101 email
Field Studies Council is a limited company (No.412621) a charity (No.313364) registered in England and Wales and in Scotland(SC039870)