Deadline for applications: Friday 13th May 2011 Please read the accompanying guidelines before completing the form APPLICATION FORM Shakespeare and His Stage, Cultural Seminar for Teachers at Shakespeare’s Globe Sunday 7-13 August 2011 Completed forms should be returned to: Education Department- education@esu.org
Personal Details Country applying from: Please attach a passport sized portrait photograph of yourself to the front sheet or attach separately to your email Title: First Name:
Family Name:
Other names: Please indicate by which name you prefer to be known, by putting it in bold Date of birth:
Gender:
Place of birth:
Nationality:
Emergency contact details Name: Relationship to you: Phone number including international dialling code: Passport and Visa Information The information requested below is required when processing your visa and will not be used for any other purpose Passport Number: _____________________________ Do you require a visa to enter the UK? YES
NO
Do you require a formal letter of invitation from the ESU in order to acquire a visa? YES
NO
Please give your name as it appears on your passport:
Flight details – these must be provided in advance (please note, delegates should arrive in time for the programme beginning on Sunday 7th August and should not leave before Sunday 14th August. Late arrival will lead to instant disqualification from the course.) Arrival airport
Flight number
Arrival time (GMT)
Contact details Address to which all correspondence should be sent: _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Home/ Mobile phone: _______________________ Work phone: ______________________ Email: What is the best way of contacting you: _________________________________________ Dietary requirements Please let us know if you are vegetarian or have other medical/ethical dietary requirements. Though we will endeavour to ensure that all dietary requirements will be catered for, it cannot be guaranteed at all meal times. Please tick
I am vegetarian
I have other dietary requirements
[Please give details below]
Health Please include details below of any medical conditions you may have or medication you are taking and of which we should be made aware. [These details will remain confidential]
Academic/Employment details Please fill out the relevant sections – see notes for details
Current occupation: Current place of employment/study: Please list all institutions of education attended from the age of 18 and qualifications obtained. (Name of institution, dates (from and to) and qualifications obtained- year and grade):
Languages spoken (please state whether advanced, intermediate or basic):
Have you ever visited the UK before? If so, please state when and reason for visit:
Please list your interests and achievements:
Specific experience relevant to application:
Please declare if you have already participated in an ESU programme; please specify which one and whether you received a scholarship place:
Shakespeare Discussion
Please could you respond to the following two questions on a separate sheet ensuring your name is on each additional sheet. The topic of Shakespeare "translated" and a "Shakespeare Speaking Union" will be discussed during the course. 1) When was Shakespeare first introduced, translated and performed in your country? 2) When was Romeo and Juliet first translated and first performed in your country?
Personal Statement Please submit your Personal Statement on a separate sheet ensuring your name is on each additional sheet. Please explain in no more than 400 words, how you think you would benefit from the ESU Cultural Seminar for Teachers at Shakespeare’s Globe and how the experience would help you in your current work and future ambitions.
I have read and understood the guidelines for applying for a scholarship to the ESU. Declaration I declare that the information given above is correct: Signature
Date: