APPLICATION FORM FOR AN IAN GASS BURSARY
Name: .............................................................................................................................................
Address: .........................................................................................................................................
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Telephone: .....................................................................................................................................
Email address: ...............................................................................................................................
Please complete this cover sheet and the application form overleaf. Applications from small
groups should be submitted on one form giving details of the contact name and address on the
main form with details of other applicants listed on a separate sheet. Completed forms should be
sent as an e-mail attachment to Env-Earth-Ecosystems-Enquiries@open.ac.uk to arrive by
midnight on 31 January 2016. Alternatively, postal applications may be sent to the Department
Administrator, Department of Environment, Earth & Ecosystems, The Open University, Walton
Hall, Milton Keynes, MK7 6AA to arrive by 31 January 2016.
OU PI:
OU Modules Studied and Grades Awarded (Earth Sciences modules first):
eg S104 (Pass), SXG290 (Pass 2)
OU Degree Awarded?
If so, date and class:
Any non-OU Earth Sciences studies:
Qualifications and dates:
Geological interests outside OU (if these are work-related please state this):
Total amount of funding requested and breakdown (e.g. travel, accommodation, etc.):
Item
Amount (£)
Total: £
Do you already hold/have you applied for any grants/awards for this work?
Ian Gass Bursary Application Form 2016
Title and outline of proposed project:
A continuation sheet may be used for this section if necessary.
Title of proposed project
Introduction
Proposed area of study
Aims and objectives
Proposed method
Potential for public outreach and plans for dissemination, including proposed format of project
report
Reference list
Continuation sheet attached? Yes/No (delete if inapplicable)
Signature
Date
Ian Gass Bursary Application Form 2016