NAME   ..............................................                        Forenames    ........................................................................

 Date of birth   .....................................                         Place of birth   .....................................................................

 Address   ..........................................................................................................................................................................................

                 .........................................................................................................................................................................................

 Tel.   ...............................  Mobile   ...............................             email   ...........................................................................................

Educational achievements  -  subjects & grades:                                                                      Year obtained:

 School   ................................................................................................................................................................

 College / University   .............................................................................................................................................

                                   ...........................................................................................................................................

                                   ...........................................................................................................................................

 Current university / college / employer

Name   ................................................                        Course / department   ...........................................................

Address   ..................................................................................................................................................................

Referees  (it may be helpful for the Guild to contact someone about this application)

 
1. Name   ........................................... Address  ..............................................................................................

                                                              ........................................................   Tel. no.  ...................................

 2. Name  ............................................ Address   ............................................................................................

                                                               .......................................................     Tel. No   ...............................         

Please attach to this form an outline of the project .

Note.  In making and signing this application you hereby agree to providing, in confidence,  information about yourself, your career, and the need for and use to which the scholarship money will be put.  You also agree, if you are awarded a  scholarship, to provide a report to the Welsh Livery Guild on your use of the scholarship, and you also agree to your name and photograph being used in Welsh Livery Guild Awards publicity.

the name of the local newspaper where I live is   ...................................................

SIGNED   ..............................................                                                        Date   ..........................