ࡱ> @B?M bjbj== ..WW l***>P P P P d T>   # # # hjjj=$ "*#  "# # # 1 '111# 8 * h1# h101a* m) > P ? d0  1>>Please keep a copy of your form, and return the original signed form by 17th February 2006 and email a copy to  HYPERLINK mailto:nl@stammering.org nl@stammering.org   THE BRITISH STAMMERING ASSOCIATION Registered Charity No. 1089967, Registered Company No. 4297778 15 Old Ford Road, London E2 9PJ Telephone: 020 8983 3591APPLICATION FOR A BRITISH STAMMERING ASSOCIATION VACATION SCHOLARSHIP Please do not send additional material. There should only be ONE application per Candidate and/or per Project Supervisor. 1. STUDENT: Mr/Ms* Surname: First name and middle initial(s): 2.Date of birth: 3.University/College (where full time undergraduate, or Masters student): 4.Type and subject of degree:5. Date degree course commenced: 6.Length (in years) of degree course. (Undergraduates and Masters students are eligible). Candidates should normally be in the middle year(s) of their course: 7.Summary of courses taken and completed (with results): 8. Period for which support is sought (max 8 weeks): Proposed starting date:9. PROJECT SUPERVISOR (ie. where the project is to be undertaken awards are made to the sponsoring institution) Title: Surname: First name and middle initial(s):  Present post (please state with whom contract of employment is held):  Department and full postal address:  Telephone/fax/e-mail: Head of Department I confirm that I have read this application and the conditions set out on the BSA website and I agree to this research being carried out in my department and to abide by the terms of the relevant grant conditions. Signature of Head of Department: Print name: Date: Secretary/Finance Officer of Institution I confirm that if a grant is made I will ensure that the funds provided are used for the purpose for which they have been given. I also confirm that it is our intention to maintain support for this department during the period for which the grant is requested and to abide by the terms of the relevant grant conditions. Signature: Print name: Position: Date: Name of student: Institution: RESEARCH PROJECT:  Title of Project: 11. Short statement of the proposed research showing (i) work leading up to the project, (ii) the objectives and (iii) method of investigation (continuation of undergraduate projects will not be considered): 12. Is ethical approval required for this project?* Yes No 13. Recommendation of Student by Project Supervisor/Head of Department or, if not personally known, by Students current Tutor: Signature of Project Supervisor/Tutor: Date Name (if not project Sponsor): : * delete as appropriate Please return the original signed form to: Norbert Lieckfeldt, British Stammering Association, 15 Old Ford Rd., London E2 9PJ and email a copy to nl@stammering.org. 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