GWS form 2

Your Name

Your ac.uk email (ac.uk address required)

Your department/institution

Title of your proposal

Details of Supervisor or Head of Department, whom we shall contact to offer a reference in support of this application:

Name

Email address

Is this person your:

SupervisorHead of School/Department

Please note, we do not consider your application complete until we receive the reference

REQUIRED: I consent to scudd.org.uk collecting my data from this form only for the purposes of forwarding it via email. I understand that none of my personal information will be stored on this website's server.

Please contact Glenn Odom if you have any queries about this form