APPLICATION FOR A BRITISH COUNCIL
ELT SCHOLARSHIP

This form will be photocopied. Please complete in typescript or black ink

Section A

1	Surname		
			
	First name		
			
	Nationality		
			
	Date of birth		
			
	Place of birth		

	Age on 31.12.2004		

2	Address for correspondence	Home	School	

	Telephone:			
				
	Fax:			
				
	E-mail:			

3	Teaching position	
	No. of years full time teaching experience		

	Please state the date of “immissione in ruolo”
(not including “anno di formazione”)				

	Your age on  31.12.04		

	School Address:		

	Date current teaching position commenced				

	Please give details of any additional responsibilities or special roles you have at school:
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4	Professional training qualifications and scholarships	

	Please give details below of any training courses or events related to English Language Teaching you have attended of 20 hours or more only in the last 5 years in Italy	

	Dates of course	Title of course	Organizing Institute department association	

				

	Please give details below of any training courses for teachers of English attended in Britain or the USA since 1990, including any scholarships you have been awarded	

	Dates of course	Title of course	Institute	Scholarship awarded	

					

					

					

5	Teacher training experience	

	Have you had any experience in the role of Trainer (formatore/formatrice in any Ministry of Education projects? Please give details below: 
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Please attach a type- written statement (300 – 500 words) stating how you think a trainer training course would benefit you professionally and how you might be able to put your training to practical use after the course.

Please include an up to date CV
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I declare that the above statements are true and understand that my scholarship may be cancelled if any false statement has been made as part of this application.
Signature:___________________________________________

Date:_______________________________________________