Amtmann Fellowship Application Form

The completed application form and three copies must be postmarked no later than September 30 2010 and be sent to:

Chair, Fellowships Committee
Bibliographical Society of Canada
P.O. Box 575, Postal Station P
Toronto, Ontario M5S 2T1

Application for the following fellowship:

Amtmann (2011)

Name: _______________________________________________________________

Telephone: ____________________________

Address: ______________________________________________________________

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Institutional Affiliation: __________________________________________________

Position: ____________________________________________________________

Education: _________________________ Degree: __________

Date: ___________

Discipline: _________________________________________________________

Significant Publications:

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Relevant Experience:

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Title of Project:

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Summary of Project: Please attach a summary that can be used for the announcement of the award.

Description of Project: Please attach a description (not to exceed four pages) which includes objectives, significance, organization, and methods employed in your project, as well as work completed, in progress, and to be undertaken; you may wish to send samples of your work.

Budget: Please attach specific information regarding costs, including fares, mileage, duration of travel, daily expenses, and technical services or supplies.

Indicate any other support, either granted or requested for this project.

References: Please provide the names and addresses of the two persons who have supplied the sealed letters of reference you have included in support of your proposal.

1. ______________________________________________________________

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2. ______________________________________________________________

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Signature : _____________________________ Date : ______________________