06.09.2006
JOHN SMITH FELLOWSHIP PROGRAMME 2007 APPLICATION FORM
The John Smith Memorial Trust is working to promote equal
opportunities in and through its Fellowship Programme. The aim of our
policy is to ensure that all those who come into contact with the
Trust or the Fellowship Programme receive equal treatment across
ethnic or national origins, religion, gender, marital status,
disability, sexual orientation, age or class, and are not
disadvantaged by conditions or requirements that cannot be shown to be
justified.
Please complete all parts of this form in typescript as a digital file
to be emailed by November 7^th 2006 to the British Council. A printed
copy, with your original signatures and photograph, is also required.
PART A: PERSONAL DETAILS
Family name:
(as in passport)
Other names:
Mr Mrs Miss Ms Dr Male Female
Title: Sex:
Date of birth:
Nationality:
(as in passport)
PLEASE NOTE: If your application is successful the photograph attached
here may be used by the John Smith Memorial Trust and British Council
in Fellowship Programme literature.
How did you first hear of the John Smith Fellowship Programme? Please
give details of any advertisements, press reports, websites, etc.
Please mention other sources you have used for information, too.
Languages spoken:
Foreign languages spoken (please state proficiency level and list
languages spoken):
Address for correspondence in home country:
Telephone number:
Email address:
Name and address of next of kin or person in your country who should
be contacted in the event of an emergency (please state relationship
to you):
Telephone number:
Email address:
Do you have any special requirements, i.e. mobility, religious,
dietary, health, or related to a disability? If so, please provide
details:
Languages spoken:
Foreign languages spoken (please circle proficiency level and list
languages spoken):
Under the John Smith Fellowship Programme, we cannot pay married or
child allowances; any allowances you receive are intended to cover
your expenses only. If any members of your family intend to accompany
you to the UK you will have to meet their costs yourself.
PART B: ACADEMIC BACKGROUND
Please list all academic qualifications obtained since completing your
secondary education, stating the institutions attended and when the
main courses started and finished. Please indicate with an asterisk
(*) those courses where the language of instruction or supervision was
entirely or mainly English:
Qualifications
(including class or level)
Institution
Subject
From
To
Computing/IT skills (please describe)?
PART C: PROFESSIONAL BACKGROUND
Please list all positions held since completing your university
education, stating your job title. This should include paid employment
and, if relevant, any voluntary activities.
Position
Organisation/Institution
From
To
PLEASE RESPOND TO THESE QUESTIONS USING A MAXIMUM OF 300 WORDS. LONGER
ANSWERS MAY NOT BE CONSIDERED.
Who is your current employer? If you work in the public sector, please
tell us what department you work in and describe briefly its role
within the wider organisation. If your employer is an NGO or private
sector organisation, please enclose details of the organisation with
this application, including the number of paid staff. If your
organisation relies on volunteers, how many are active in its work?
Please respond in no more than 300 words.
What is your current job? Please describe your main responsibilities
including areas of policy covered, and the number of people who work
for you or under your supervision, if applicable, and where you fit
within your organisation. Tell us how your job relates, directly or
indirectly, to one or more of the following: good governance, the
improvement of human rights or public services, media reform, economic
reform, political reform, or the provision of support for
disadvantaged groups. Please respond in no more than 300 words.
PART D: OTHER INTERNATIONAL EXPERIENCE
Have you ever visited the UK before? If so, please indicate when it
was, your length of stay, and the purpose of your visit:
Dates
Purpose
Have you ever lived, worked or participated in scholarships outside
your home country? If so, please indicate when it was, your length of
stay, and the purpose of your visit:
Dates
Purpose
PART E: PROGRAMME OBJECTIVES
Please state in the space provided below
a. What do you understand about the nature and aims of the John Smith
Fellowship Programme and what is expected of participants? Please
respond in your own words and using no more than 300 words.
PLEASE RESPOND TO THESE QUESTIONS USING A MAXIMUM OF 300 WORDS. LONGER
ANSWERS MAY NOT BE CONSIDERED.
b. Why you wish to undertake the Fellowship? Please respond in no
more than 300 words.
c. What are the main subjects you would like to explore during the
Fellowship and what are the main areas of UK Governance you would
like to learn about? Please respond in no more than 300 words.
PLEASE RESPOND TO THESE QUESTIONS USING A MAXIMUM OF 300 WORDS. LONGER
ANSWERS MAY NOT BE CONSIDERED.
d. How do you intend to use what you learn during the Fellowship to
influence one or more of the following areas, directly or
indirectly, on your return: the provision of public services; good
governance; the improvement of support for disadvantaged groups;
media reform; good economic management; the improvement of human
rights? Please respond in no more than 300 words.
PART F: ATTACHMENTS PROGRAMME
Before completing this section, please refer to the note on
attachments which accompanies this form.
The Fellowship includes a two-week individual work attachment, which
should complement the experience and interests of each fellow.
Previous placements have involved government departments, NGOs,
academic institutions, research organisations, trade unions, political
parties and the media. Please outline the nature of the organisation
you wish to work with and briefly describe your aims and the issues
you wish to cover. If you have an interest in any particular
organisations in the UK, please provide details:
DATA PROTECTION: YOUR PERSONAL INFORMATION
The British Council will use the information completed by you as part
of the selection process for the granting of a John Smith Fellowship,
according to the criteria set by the Department for Constitutional
Affairs (DCA) and the John Smith Memorial Trust (JSMT). If selection
is successful your information will be used to set up and administer a
programme designed to meet your needs. It will also be used to
evaluate and report on the outcome of your programme. Evaluation will
include follow-up contact with you by the British Council and John
Smith Memorial Trust after you have returned home.
Your information will be used within the British Council for these
purposes only, and will also be disclosed to the Department for
Constitutional Affairs, the John Smith Memorial Trust and the
institutions and organisations which you will visit in the UK, for the
same purpose only. Your photograph is required for the purpose of
identification, but if your application is successful, it may also be
used on the John Smith Memorial Trust website or in other Programme
literature. Your name and the dates of your visit will be passed onto
an insurance company for the purpose of medical insurance to cover
your stay in the UK.
If you have provided details of special requirements i.e. mobility,
religious, dietary or disability requirements, this will be used by
the British Council to provide for them. By returning this form to us
you consent to our processing this sensitive personal data about you
where this is necessary for this purpose.
Under the 1998 Data Protection Act you have a right to ask for a copy
of the information we hold on you, for which we will charge a fee.
Contact the Data Protection Officer by email at
dataprotection@britishcouncil.org or send in your request to the Data
Protection Officer, The British Council, 10 Spring Gardens, London
SW1A 2BN. If you feel that the information we hold about you is
inaccurate please contact the British Council.
I, the undersigned, have read and agree to the above provisions:
Signature: Date:
You must provide the following documentation along with this
application form (please tick):
* A recent passport-sized photograph (in colour)
* Photocopies of academic certificates (and translations if
relevant)
* Letters from two referees, of which at least one should be
professional. Please note that all references for short listed
candidates are checked by the British Council, so you must
provide contact details for each referee.
* Information about your employer as requested in Part C of this
application (if relevant).
S
8
Photograph
First heard about Fellowships through:
Other sources of information used:
DECLARATION: PERSONAL RESPONSIBILITY AND ETHICS
The John Smith Fellowship Programme is inspired by principles of
tolerance, respect, gender equality and ethical behaviour. I, the
undersigned, declare that if offered a place on the John Smith
Fellowship Programme, I will seek to promote these principles in my
own interactions with other Fellows and with the many people I meet in
the United Kingdom during the Programme. I understand that the John
Smith Memorial Trust reserves the right to withdraw a Fellowship from
any individual whose behaviour it deems to fall seriously short of
these principles during their time on the Fellowship Programme.
................................
Signed:
Date:
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