TPHOLs 2001 Student Bursary Application Form
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Last name: ______________________________________________________________

First name(s): __________________________________________________________

Address: ________________________________________________________________

         ________________________________________________________________

E-mail address: _________________________________________________________

Telephone number: _______________________________________________________

Fax number: _____________________________________________________________


Institution where registered as a student:

_________________________________________________________________________

Department within institution: __________________________________________

WWW URL of institution: _________________________________________________

Degree for which you are studying (e.g. PhD, MSc, BSc): _________________

Name(s) of supervisor(s), advisor(s), or course organiser(s):

_________________________________________________________________________

Date of commencement of course (matriculation): _________________________

Expected finishing date: ________________________________________________


Are you an author of an accepted Category A paper
or a submitted Category B paper at TPHOLs 2001 (Y/N)? ___________________

If yes, give title(s) of paper(s):

        _________________________________________________________________

        _________________________________________________________________

        Will you be presenting the work yourself (if it is accepted)? ___


Will you also be registering for CHARME 2001? ___________________________

Estimated costs (in UK pounds) including
travel, accommodation and registration for TPHOLs: ______________________

Amount (UK pounds) for which you would like to
receive a bursary (no more than 500 UK pounds): _________________________