Strictly Confidential
The Geological Society of London

APPLICATION FOR 
A DISTINGUISHED GEOLOGISTS MEMORIAL TRUST BURSARY

Please complete all boxes and return to the Chartership Officer with a statement of how the bursary will be used (limited to 2 pages) and letters of support from a chartered Fellow and your employer.  

Name in Full:

	Date of birth:
	
Degree and date:			Fellowship number

	
Employer and present position:

	
Address:

Tel:						E-mail
	
Title of Project:

Amount requested and breakdown of expenses:

	
Funds available secured/pending 

	Details of any previous awards from the GSL
Applicants who have had a previous award from the Society but who have not submitted an interim or final report will be disqualified.	
Names and titles of those providing supporting letters.

	

Bibliography/list of references (own publications or  articles relevant to this application)

	

Project Description: (not to exceed 2 x A4 equivalent pages; not less than 10 font size)