WALTER HINES PAGE AND CHAUTAUQUA SCHOLARSHIPS 2012 – 2013
This application form must be typed and be accompanied by: - a covering letter - a recent professional reference/testimonial - a medical certificate providing evidence of fitness to undertake a strenuous tour - four passport sized photographs bearing the candidate's name on the back.
Name & title: Date of birth: Nationality: Home address, telephone number and e-mail (required):
School address, telephone number and e-mail (required):
Please state whether you are interested in applying for a Walter Hines Page Scholarship, a Chautauqua Scholarship or both.
Which Educational Association/Union’s scholarship are you applying for? -Applications need to be made to the Union of which the applicant is a member
Position held:
Subjects taught:
Teaching experience in the last five years:
Education and qualifications gained:
Experience of overseas travel:
Experience of public speaking:
Do you have any contacts in educational institutions in the USA you wish to visit, please elaborate if necessary?
Can you confirm that your local authority and/or governing body will grant you the necessary leave of absence (Chautauqua = 2-4 weeks starting in the 4th week of June 2011, Walter Hines Page = 2 weeks between mid-October 2011 and mid-May 2012)?
Are you in a position to pay the remaining travelling and incidental expenses?
Please give the name and contact details of the referee who has provided your reference: Name: Address:
Email: Phone number: What are your reasons for applying for a Walter Hines Page scholarship?
Describe briefly what aspects of education you wish to study in the USA:
What are your aims and objectives for the Page scholarship?
How would a Page scholarship benefit your work, colleagues and union?
Is there any other information you would like to give? Please continue on a separate sheet if necessary.
Where did you hear about the scholarship?
THIS APPLICATION SHOULD BE RETURNED TO YOUR UNION/ASSOCIATION BY 24 NOVEMBER 2011