Declaration Forms

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					                                                                                  UK 9/11
                                                                                     Scholarships
                                                                                     Fund
Declaration form
Once you have completed and submitted your application, you must also include a completed and signed copy of
this declaration form.
Applicants from the United States should send       Applicants from other countries should send
their completed forms to:                           their completed forms to:
UK 9/11 Scholarships                                UK 9/11 Scholarships
Scholarship America                                 British Council
1505 Riverview Road                                 Development Services
PO Box 297                                          Bridgewater House
St Peter                                            Whitworth Street
MN 56082                                            Manchester M1 6BB
United States of America                            United Kingdom




Please attach letters from two referees/references (for example, a teacher at your current school) in support of
your application for a UK 9/11 scholarship.
First referee/reference
Title and name
Position
Address


Telephone (          )
How long have you known this referee/reference?
What is his/her professional relationship to you?


Second referee/reference
Title and name
Position
Address


Telephone (          )
How long have you known this referee/reference?
What is his/her professional relationship to you?




I confirm that all the information I have given in both my application form and my declaration form is correct to the
best of my knowledge.




Signature                                                                  Date