Tempe Mann Travelling Scholarship

Please read the Guidelines before completing this form

Family Name:
Given Names:
Date of Birth:
Home Address:
Home Phone Number:
Mobile Phone Number:
Email:
Degrees held:
Current post graduate degree enrolment:
Faculty/School:
University:
Candidature Commencement Date:
Expected Candidature Completion Date:
Thesis Title:
Brief outline of proposed thesis project:
Outline of purpose for which the AFGW NSW Tempe Mann Travelling Scholarship funds will be used and justification for the travel required (250 words max):
Proof of enrolment or acceptance from the university or other institution at which you propose to conduct your short period of research (email or letter):
 
Detailed budget summary for the above purpose (include fares, accommodation, fees, etc):
Other financial support granted or applied for:
Any additional brief information (optional):
Publications:
Prizes, scholarships, other awards received:
Names, telephone nos. and email addresses of your supervisor and your independent academic referee: