2016 / 2017 courses

Application for sponsors

Charity Registration number 328142

READ APPLICATION GUIDANCE BEFORE COMPLETING THIS FORM
Name
Address
Home Telephone
Mobile / Work
Email
Date of Birth / Age
Gender / Male / Female
Name of college
offering place
Title of course applied for
Course level
Length of course
College address
Course administrator (if known)
Ethnic Monitoring Information (Please tick as appropriate)
Mixed White & Black Caribbean
Mixed White and Black African
Mixed White and Asian
Other mixed
Indian
Pakistani
Bangladeshi
Other Asian
Black Caribbean
Black African
Black other
Qualifications and Training (Use additional paper if necessary)

Starting with the most recent, please give details of your education, qualifications and training.

Date / Details of education and training to date / Grade
Previous Employment (Use additional paper if necessary)

Starting with the most recent, please give details of your past employment.

Date / Employer, brief description of duties / Reason for leaving
Have you applied for a grant for this course?
Yes
No
If yes please give details and use additional paper if necessary
Organisation / Date / Amount / Details of application / Outcome
Have you approached any companies for sponsorship?
Yes
No

If yes please give details and use additional paper if necessary

Organisation / Date / Amount / Details of application / Outcome
ABOUT YOU
Why have you chosen to work in the media? Use additional paper if necessary
Which area of the media would you like to work in? (Use additional paper if necessary)
What is your ultimate career aim? (Use additional paper if necessary)
How will you use this course to help you achieve your career aim? (Use additional paper if necessary)
What have you done so far to further your interests in journalism? (Use additional paper if necessary)
George Viner Memorial Fund Trust

Application Form Budget

Qty / Price / Total / Comments
Expenditure
Accommodation
Books
Course Fees
Travel Costs
Other Expenditure
Total Expenditure
Income
George Viner Sponsorship
Other income
Total Income
Surplus
Total amount requested from the George Viner Memorial fund / £

Please provide details of two people who would be willing to provide references.

Referee 1
Name
Address
Telephone
Relationship to applicant
Referee 2
Name
Address
Telephone
Relationship to applicant

Please see the website for details of the deadline. Applications received after the deadline will not be accepted under any circumstance. If you are posting your form close to the deadline date you are advised to send it by guaranteed delivery.

Applications should be returned by post to:

Holly Page - The Fund Administrator

George Viner Memorial Fund

Headland House

308-312 Gray’s Inn Road

London

WC1X 8DP

I declare that the information given on this form is correct and complete.

Signed: Date: