UNIVERSITY OF CAMBRIDGE

UNDERGRADUATE APPLICATION FORM

SIR BARTLE FRERE'S MEMORIAL FUND / WORTS TRAVELLING SCHOLARS FUND
To be received by the Mr Hugo Hocknell, Secretariat, The Old Schools, Trinity Lane, Cambridge, Cambridge not later than 1 March.

APPLICATIONS RECEIVED AFTER THIS DATE WILL NOT BE CONSIDERED BY THE COMMITTEE. _____________________________________________________________________________________ _
APPLICATION FOR :
(Applicant to tick box)

WORTS TRAVELLING SCHOLARS FUND BARTLE FRERE EXHIBITION

Also referred to as Sir Bartle Freres Memorial Fund

THIS IS A GROUP APPLICATION

1.

Full name of Applicant (Block letters, surname first) and title

Applications by members of Expeditions or of groups travelling together should include on a separate sheet a complete list of those taking part in the expedition, with a summary of the University record of each of them, including name, College, Tripos and class in all examinations taken in previous years (give dates), particulars of any examination to be taken in the year of this application, and degrees awarded, if any.

2.

College

3.

USN/Student Number

4.

Address to which correspondence is to be sent

5.

Faculty/Department

6.

Date of Birth

7.

Course and Year of Study

7.

Summary of applicant's University record and particulars of any examinations to be taken in the year of this application.
Institution Subject Date Subject(s) Grade(s)

8.

State here in not more than 12 words the destination(s) and purpose of your journey.

On a separate sheet give a detailed typed statement of your proposed subject of study or research at the place(s) to be visited, or the object of your expedition. Documents submitted should be suitable for photocophing on A4 size paper.

please turn over/

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9.

Intended departture date Intended return date

DD/MM/YY DD/MM/YY

10.

Estimated expenditure:
(i) (ii) (iii) (iv) Travel Subsistence Equipment Any other expenditure ... ... ... ... ... ... ... ... ... ... ... ... Total estimated expenditure _________________

Please provide a breakdown of this expenditure 11. Amount still required Including amount requested in this application. Amount requested in this application
Please note that these awards are for limited amounts only

12.

13.

Referees (Important - Please see attached reference sheets)

Please give names (including title and initials) and full addresses of two senior people acquainted with your academic work to whom you have passed the reference sheets.

Referee 1

Referee 2

14.

Any other information which you wish to submit including, in the case of expeditions, whether the expedition has been approved by the Cambridge Expeditions Committee. Please continue on a separate sheet of A4 if required.

15.

Please state how you will be occupied in the academic year following the year of this application.

16.

Signature by the applicant and applicants Tutor

I certify that the information given in this application is correct

Applicants signature Tutors signature

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _Date __

_________________

_ _ _ _ _ _ _ _ _ _ _ _ _ _Date __ _

_________________

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THIS APPLICATION FORM IS FOR UNDERGRADUATE STUDENTS ONLY

NOTES ON ELIGIBILITY FOR SIR BARTLE FRERE'S MEMORIAL FUND / WORTS TRAVELLING SCHOLARS FUND

(a) (b)

The Worts Fund covers all foreign countries; the Bartle Frere Fund covers Commonwealth countries excluding Bangladesh, India, Pakistan and the UK. In considering Bartle Frere applications preference is given where appropriate to Postgraduate Students intending to spend the period of tenure undertaking research, but undergraduates may also apply. In considering Worts Fund applications preference is given where appropriate to undergraduates, but Postgraduate Students travelling to nonCommonwealth countries or to Bangladesh, India and Pakistan may also apply. Undergraduate applications will be considered separately by the Managers of the Mary Euphrasia Mosley Fund and will receive notification of the result of the application from the Secretary of the Mary Euphrasia Mosley Fund during May. In all cases, the Managers are unlikely to make awards to applicants who do not present both a good academic record and a good project proposal. The Managers do not expect there to be sufficient funds to support the following activities: participation in study programmes or language courses, or in conferences (either to present a paper or to attend), or in charitable activities; fieldwork for M.Phil. theses; medical electives; seeing veterinary practice; travel after the completion of a degree. Applications by members of Expeditions or groups travelling together should be made on one form. In such cases the entries of income and expenditure at sections 8, 9, 10 and 11 should relate to the Expedition or group as a whole. Postgraduate applicants to both Worts and Bartle Frere should not expect to hear a result of their application before mid May. Successful applicants must collect their award during the financial year 2004/05. If your fieldwork is postponed your award will lapse and you will be required to re-apply in the next academical year. If you have already collected your award you will have to pay it back to the Committee.

(c)

(d)

(e) (f)

(g)

(h) (i)

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REFERENCE REQUEST FORM 'A'

UNIVERSITY OF CAMBRIDGE

Undergraduate Application for Financial Assistance from : SIR BARTLE FRERE'S MEMORIAL FUND and/or the WORTS TRAVELLING SCHOLARS FUND Part 1 (to be completed by applicant)

Name of student ________________________________________________________________ Award Scheme applied for : Sir Bartle Frere's Memorial Fund Worts Travelling Scholars Fund
(See Criteria for each scheme on Application form)

GIVE THIS FORM TO YOUR FIRST REFEREE

Part II (for the attention of the Academic Referee) 1. The applicant named above is applying for financial assistance from one of the award schemes listed above. The criteria for each scheme is described on the application form, 2. The Committee would be most grateful if you could provide them with a reference in connection with this application, a copy of which the applicant has been asked to make available to you. 3. You are asked to provide an assessment of the applicant's progress in his/her study to date, bearing in mind that one criterion common to both award schemes, is a high level of diligence and progress. In order that the Committee make the best use of the limited funding available for the award schemes, they would be grateful if you would comment in particular on (a) (b) the accuracy of the information given, and any financial contribution which has been, or may be, made by your Faculty/Department.

4. The applicant has been asked to arrange for a tutorial reference in support of the application to be sent to the Committee by his/her College Tutor. Please send your written reference direct to Mr Hugo Hocknell, Secretariat, The Old Schools, Trinity Lane, Cambridge. 5. It would be helpful to receive your reference by 10 March.

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REFERENCE FOR

Please indicate by ticking the appropriate box whether you agree or do not agree to this reference being released to the person in respect of whom it is written if that person seeks disclosure. If you do not complete this declaration, it will be assumed that you WOULD NOT agree to release your reference if the person concerned seeks disclosure. PLEASE NOTE that there may be circumstances under which the University would be required to make a disclosure irrespective of your wishes but the University would treat your reference in strict confidence insofar as the law permits. I do agree to the release of this reference if the person concerned seeks disclosure I do NOT agree to the release of this reference

FROM DATE

SIGNED

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REFERENCE REQUEST FORM 'B'

UNIVERSITY OF CAMBRIDGE

Undergraduate Application for Financial Assistance from : SIR BARTLE FRERE'S MEMORIAL FUND and/or the WORTS TRAVELLING SCHOLARS FUND Part 1 (to be completed by applicant)

Name of student ________________________________________________________________ Award Scheme applied for : Sir Bartle Frere's Memorial Fund Worts Travelling Scholars Fund
(See Criteria for each scheme on Application form)

GIVE THIS FORM TO YOUR SECOND REFEREE

Part II (for the attention of the College Tutor) 1. The applicant named above is applying for financial assistance from one of the award schemes listed above. The criteria for each scheme is described on the application form, 2. The Committee would be most grateful if you could provide them with a reference in connection with this application, a copy of which the applicant has been asked to make available to you. 3. You are asked to provide an assessment of the applicant's progress in his/her study to date, bearing in mind that one criterion common to both award schemes, is a high level of diligence and progress. In order that the Committee make the best use of the limited funding available for the award schemes, they would be grateful if you would comment in particular on (a) (b) the accuracy of the information given, and any financial contribution which has been, or may be, made by your Faculty/Department.

4. The applicant has been asked to arrange for a tutorial reference in support of the application to be sent to the Committee by his/her College Tutor. 5. Please send your written reference direct to Mr Hugo Hocknell, Secretariat, The Old Schools, Trinity Lane, Cambridge.

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REFERENCE FOR

Please indicate by ticking the appropriate box whether you agree or do not agree to this reference being released to the person in respect of whom it is written if that person seeks disclosure. If you do not complete this declaration, it will be assumed that you WOULD NOT agree to release your reference if the person concerned seeks disclosure. PLEASE NOTE that there may be circumstances under which the University would be required to make a disclosure irrespective of your wishes but the University would treat your reference in strict confidence insofar as the law permits. I do agree to the release of this reference if the person concerned seeks disclosure I do NOT agree to the release of this reference

FROM DATE

SIGNED

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