Student Bursary Application Form
Social Cohesion in Times of Uncertainty
Sunday 24th – Monday 25th September 2017
Personal Information
Title (if any)
Full Name
Email
Contact Number
Equal Opportunities Monitoring (Optional)
Age
Gender
Ethnic Origin (as described by Office for National Statistics
Nationality
Country of Birth
Are you the first person in your family to attend university (Y/N)?
Academic Information
Subject
School/Department
Degree/Level of Study
University
Expected Date of Completion
Previous Degrees (if applicable)
Subject
School/Department
Degree/Level of Study
University
Date Completed
Subject
School/Department
Degree/Level of Study
University
Date Completed
Supporting Statements
Statement of Financial Need
Please explain why you are applying for financial assistance to attend this conference (250 words
maximum):
Supporting Statement
Please provide a statement in support of your application. This should include how the bursary will
benefit you, what you hope to contribute to the conference as a delegate, and anything else which
may help to support your bursary application (500 words):
Academic Referee
Please provide details of an academic member of staff (usually a supervisor) who would be willing to
provide a reference in support of your bursary application:
Title (if any)
Full Name
University/Academic Affiliation
Job Title
Relationship to Applicant
Email
Contact Number
Address
Market Research
To help us with our market research, please tell us how you heard about this conference and the
student bursary scheme:
Please return to: Dr Rachel Smillie, Education Officer (Universities and Schools)
Cumberland Lodge, The Great Park, Windsor, Berkshire SL4 2HP
T: 01784 497781
E: [email protected]