EMMANUEL UNITED REFORMED CHURCH, CAMBRIDGE
			  MISSION BURSARY APPLICATION FORM 

FULL NAME  ............................................Title (Rev. Dr. Mr. Mrs Ms etc.)................  
Nationality ..................................................				Age .........................
Single/ Married......................................     Dependant Children ( with age )...............
e-mail    ........................................................					    ..................
Postal Address  .........................................................................
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Telephone  .......................................................
Sending Church ( denomination )  ...........................................
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University Education ( or equivalent ) .  Give university and dates, faculty and specialism
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Academic Qualifications 	.......................................................................
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If Ordained, date of ordination ......................................
Level of English Language.    Would you say that 
(i) 	your English is fully fluent    or
(ii ) 	that you have a 'working knowledge' of English
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Travel/Study outside Hungary   .......................................................................
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Work Experience within the Church ( Employer, Post held and dates ) 
Present Appointment ......................................................  Date appointed ..................
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Previous appointments with dates ................................................................................
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Work Experience not Church related  ( Employer, Post held and dates  ) 
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Personal skills, talents and interests ( e.g. Arts,  Music, Drama, Sports etc...........)
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Which aspects of Church life or Society in Britain interest you especially ?
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Are you in good health  ?  ..............Yes/No  							        Do you have any medical condition that might affect you during a three-month visit.
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Probable dates available - please give order of preference 1,2,3 or indicate not available
September - December 2014 ......................      January - Apri 2015 ...........................
March - June 2015     .................................      September - December 2015 ..............
Has permission for absence been granted in principle ?  .................................
Referees ( with addresses and e-mails )  
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Please return this application not later than 20th March preferably by e-mail to 
Mr. Roger Wicks 	     e-mail  :   Roger.wicks@outlook.com   Tel. 00441223234706
30, Percheron Close, Impington, Cambridge, CB24 9YX,  UK.