Jane Austen Society UK : Travel Bursaries application form

	Jane Austen Society : Travel Bursary Application Form
	Full name		.....................................................................................
	Academic status		.....................................................................................
	Address		..................................................................................... ..................................................................................... ..................................................................................... .....................................................................................
	E-mail address		.....................................................................................
	Year of birth		.....................................................................................
	Summary of proposed Jane Austen related topic of study (please append full details as separate document)		..................................................................................... ..................................................................................... ..................................................................................... .....................................................................................
	Location(s) of proposed study		.....................................................................................
	Expected duration of study, and date of expected report		..................................................................................... .....................................................................................
	Name and address of referee		..................................................................................... ..................................................................................... ..................................................................................... .....................................................................................
	Travel and accommodation expenses		..................................................................................... ..................................................................................... .....................................................................................
	Additional expenses anticipated to support the study undertaken		..................................................................................... ..................................................................................... .....................................................................................
	Bursary amount to be applied for (reimbursable against identifiable expense vouchers)		.....................................................................................
	Agreement that the Jane Austen Society has the right to publish study report (please sign)		.....................................................................................
	Please mail completed form to: Patrick Stokes, Perram House, 71-73 East Street, Bridport, Dorset DT6 3LB, accompanied by brief CV and detailed description of study proposal. Please ensure that referee's letter is sent under separate cover.