OLD ABINGDONIAN CLUB

JOHN RAYSON (OA 1942) AWARD2014-15

APPLICATION AND REFERENCE FORM

PLEASE COMPLETE IN BLOCK LETTERS USING BLACK INK - return to:OA Club Officer, Old Abingdonian Office, Abingdon School, Park Road, Abingdon, Oxfordshire, OX14 1DE or scan and email to .

FULL NAME / Date of Birth
Current Year
Permanent address: / Address for correspondence (if different):
Telephone number(s) Home: Mobile:
E-mail:

APPLICATION

Proposed project/experience

Dates and Duration

Why you would like to undertake this project/experience and how do you expect to benefit from it?

How might this project/experience enhance your sense of ‘adventure, courage and resilience’ as well as ‘service, loyalty and commitment’ – defining characteristics of John Rayson (OA 1942) for whom this Award is named?

Proposed Total Cost of Project/Experience

Proposed Use of John Rayson Award Funds

Individual Contribution (amount you will contribute to costs)

Contributions from other Sources (list amount, source, and whether funds have been committed or not)

REFERENCES

Two referees are required, one of whom should be someone who knows you well from an academic perspective.

Academic / Personal
Name / Name
Address / Address
Day Tel / Day Tel
Mobile / Mobile
E-mail / E-mail

All applications must be received by the OA Office no later than Friday1 May 2015.The decision of the OA Committee will be made and communicated by the end of June 2015 with funds granted in July 2015. Award recipients are to provide a written and illustrated report of their project/experience, and insights gained, to the OA Committee within two months of completing their project/experience. Award recipients must provide a breakdown of expenditure when submitting their report. This report may be published in whole or in part in The Griffen, the OA Club’s annual newsletter.

Please use this sheet to complete any sections where you have had insufficient space and to give any other information in support of your application.