Application Form
South East Europe Cultural Heritage Exchange Programme
September 2014 – March 2015
Deadline for applications: 16 May 2014
Please complete this form in full, and return it by by e-mail to:
dominica@heritagewithoutborders.org
Application Number:
Official use only
1. Please send your photo as a separate attachment
2. Candidate
Family name (surname):
First name:
Nationality:
Date of Birth (dd/mm/yyyy):
Gender:
Male
Female
Current Address:
City:
Postal code:
Country:
Contact telephone:
E-mail:
3. Educational Background:
Academic qualifications (where did you study?)
Dates:
Institution and degree obtained:
Dates:
Institution and degree obtained:
Dates:
Institution and degree obtained:
4. Employment:
Where have you worked over the past 5 years?
Please list in reverse order. The most recent should be first and the least recent last.
Dates:
Organisation:
Job title and tasks:
Dates:
Organisation:
Job title and tasks:
Dates:
Organisation:
Job title and tasks:
5. Language ability:
The programme will be conducted in English. Please rate your language proficiency from 1 (poor) to 3 (acceptable)
to 5 (fluent). We will assess your English proficiency in a telephone or Skype interview if you are short-listed.
First language
English:
1
2
3
4
5
Spoken
Written
Understanding
6. Your museum
Please answer these questions about community engagement and your museum.
6b. Are you responsible for any aspects of community engagement in your museum? If yes, please explain what the
duties are and what you enjoy about carrying them out.
6c. What challenges does your museum face with regards to community engagement? Are there barriers to
engaging audiences where you work?
6d. How would you like to change or improve the community engagement at your museum?
7. How did you find out about this programme?
8. Funding for participation
This programme has been made possible with the aid of a generous grant from the Headley Trust. The British
Council, University College London (UCL) and Heritage Without Borders (HWB) will cover the costs of participation.
This includes travel to/from the UK, in-country travel, accommodation and subsistence during participation in the UK.
Delegates’ museums must commit to hosting UK colleagues for a short visit between October 2014-February 2015.
This does not require a financial commitment from the institution, but does require a willingness to give them access
to museum facilities during their short stay (up to 4 days). The final 3-day workshop will be in Belgrade, Serbia. The
British Council and HWB will not cover travel costs to Belgrade, but will cover accommodation and subsistence costs
during it.
9. Official endorsement
We know from experience that our delegates can only benefit from our programmes when they have the full backing
of their employers. Your application will not be considered unless this section is correctly filled in and signed by the
director or chief executive of your institution.
Name:
Title or position:
Museum or organisation:
Address:
Telephone:
E-mail:
Endorses the application of the candidate named below:
Candidate’s name:
Signature of person endorsing
the application:
Date:
Stamp of institution:
10. Candidate’s statement
I declare that the above information is true and correct. I also declare that, to the best of my knowledge, my health
and my work commitments will allow me to undertake the proposed training programme:
Candidate's signature:
Date: