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Registered Charity Number: 1110348

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APPLICATION FORM

For the academic year 2024/2025 deadline MARCH 15 2024

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Personal details

Surname

Firstname

Title

Date of birth

Nationality

Address

Postcode

Telephone

PROGRAMME OF STUDY APPLIED FOR

(Course Name/Project Title/Research Area of Interest)

PROGRAMME OF STUDY APPLIED FOR

FULLTIME/PART TIME

PLACE OF STUDY

EDUCATIONAL QUALIFICATIONS

Please give details of your main qualifications to be considered. List in reverse chronological order giving the most recent first. Certificates/transcripts should be made available if requested.

Qualification Title

Grade or class

Name of institution

Awarding Body

Year

Qualification Title

Grade or class

Name of institution

Awarding Body

Year

Qualification Title

Grade or class

Name of institution

Awarding Body

Year

Qualification Title

Grade or class

Name of institution

Awarding Body

Year

PROFFESIONEL AND OTHER QUALIFICATIONS

Please give details of your main qualifications to be considered. List in reverse chronological order giving the most recent first. Certificates/transcripts should be made available if requested.

Qualification Title

Awarding Body

Year

Qualification Title

Awarding Body

Year

Qualification Title

Awarding Body

Year

EMPLOYMENT EXPERIENCE

Name and Address of Employer

Title and Duties of post

Date from

Date To

Name and Address of Employer

Title and Duties of post

Date from

Date To

Name and Address of Employer

Title and Duties of post

Date from

Date To

Name and Address of Employer

Title and Duties of post

Date from

Date To

Name and Address of Employer

Title and Duties of post

Date from

Date To

Name and Address of Employer

Title and Duties of post

Date from

Date To

Name and Address of Employer

Title and Duties of post

Date from

Date To

Name and Address of Employer

Title and Duties of post

Date from

Date To

Additional information

Please use this space to provide any additional information that you feel might be relevant. Please indicate why you would like to study abroad and in what way it will benefit you as apposed to studying in the Czech Republic.

Study date abroad / Purpose of Stay abroad / Expected Outputs / Suggested Budget

Additional information text

REFEREES

Please give two details of referees below.

REFER 1

Position

Organisation

Address

Postcode

Country

Telephone

REFER 2

Position

Organisation

Address

Postcode

Country

Telephone

AVAILABILITY FOR INTERVIEW

Please indicate any periods where you may not be available

Not available for interview

DECLARATION

I can confirm that, to the best of my knowledge, the information given in this form is correct and complete. I understand that the decision to offer me a grant rests solely with the Trustees of the Anglo Czech Education Fund and is not subject to appeal.

Signature of Applicant

Today's date

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