The Attingham Study Programme application form

Please indicate type of application*

You, your institution or a separate funding body are paying the full fee
You are applying for a full scholarship from The Attingham Trust
You are applying for a partial scholarship from The Attingham Trust

Please specify

As a full fee payer, would you like to pay the single room supplement (€540)?

Yes
No

1. General details

Name*

Title Forename Surname

Name by which you are known (for list of participants)*

Correspondence Address*

Address Line 1 Address Line 2 City County / State / Region Postcode Country

Email address*

Enter Email Confirm Email

Are you happy for your name, correspondence address and email to be held on the Attingham Trust database? This will be for archival purposes and for sending you information on future Attingham courses and events and will NOT be shared by any third party.*

Yes
No

Telephone number (Mobile)*

Gender*

Female
Male
Other

(This is required as some members will be asked to share rooms)

Nationality*

Date of Birth*

DD

MM

YYYY

Age (in September 2019)*

2. Current Employment

Job Title*

Institution*

Responsibilities*

500 characters maximum

3. Abbreviated Biography

Education/Qualifications and significant courses (with dates attended)*

Previous work experience and responsibilities (last two posts held)*

Professional interests/specialities*

Membership of relevant societies/organisations*

Select Publications (most recent/relevant)*

4. Personal Statement

Reasons for wishing to attend the 2019 Attingham Study Programme*

How did you hear about The Attingham Trust/Study Programme*

Have you previously applied to attend this course ?*

Yes
No

Please specify year*

Have you attended other Attingham courses ?*

Yes
No

Please specify which courses and year*

Please Note This course is physically strenuous and you need to be adequately fit. It is important that you have a good level of spoken English.

Letter of Professional Reference
You will be asked at the end to attach a letter of professional reference to your printed application UNLESS you have attended an Attingham Trust course in the last 5 years.

5. For Attingham Trust Scholarship Applications ONLY

Please complete the scholarship application section below

Name*

Please state your annual salary*

Gross figure, in your currency and £ Sterling

Have you asked for financial assistance from your institution ?*

Yes
No

Statement*

Please outline your request and submit a statement of up to 500 characters explaining your need for financial help and any additional information which will help us evaluate your application. NOTE: Scholarships received from The Attingham Trust do NOT cover travel expenses to or from the start of the course.

Are there any other sources of funding available to you (foundation/grants)*

Yes
No

If yes please describe*

To submit your application

Once complete, please submit the application form using the submit button below. You will receive an email confirmation with a PDF of your completed application form. Please print and send three (3) hard copies of:

a) The PDF of your completed application form
b) The letter of professional reference (if applicable and preferably on headed paper)

via post to:

Rita Grudzień
The Attingham Trust
70 Cowcross Street, London, EC1M 6EJ

Please compile them as three individual applications.

NB. These must be received at Cowcross Street by the deadline date of 12 February 2019. Any queries should be addressed to / Tel: 07876 544843

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