The Rotary Club of Bournemouth

The Rotary Club of Bournemouth

Application Form for the Peter Bath Award

Student Information

Please enter the following information about yourself

and your school and/or university

Name:
Home Address:
Postcode:
Contact Tel nos:
Email Address:
School Name:
University Name:
Teacher / Lecturer’s name (for a reference):

Instructions

This web page can either be edited by microsoft word or printed from the website. If using Microsoft Office Word, please edit the document and then print it and mail it to the postal address at the end of the form.

If you do not have access to word, Print the document off and fill in the sections in Pen and then mail it to the address at the end of the form. If you need more space for your answer to any question

just add extra sheets and reference the extra information to the

relevant questions.

However, please note that we are looking for detailed but concise answers to the questions

below; No answer need be more than 200-300 words.

Details of your proposed project at butterfly

Short description of your project:
Length and Approximate Timing of your project:
What activities are included in your project:
What do you intend to achieve with your project (for butterfly and the local community):

The project from your point of view

What do you hope/intend to achieve with your project (for yourself and your personal development):

Describe any previous voluntary work you have undertaken/do undertake:

Summary

Please summarise why you believe that you should receive the Peter Bath Award:

Student Agreement

By signing this form:-

you are confirming that at the time of travel you will be at least 18 years old

You are happy for the Rotary Club to take a reference from the teacher named at the front of the application form,

you are confirming that you will use the grant to complete the project, keeping a log of your work and using this to present your project to the Rotary Club on your return, and

You are confirming that the grant will be returned to Rotary if you are unable

or decide not to proceed with the project before august 2014.

Signature:
Name:
Date:
Parent/Guardian Signature:
Name: / Date:
Mail: Rotary Club of Bournemouth
c/o 4 Mags Barrow
Ferndown BH22 8PB / Application Deadline: 24 January 2014
Application Enquiries to: