NAME___________________________________________________________

COLLEGE______________________________

YEAR OF ENTRY______________

ADDRESS (if different) _____________________________________________

_____________________________________________

_____________________________________________

DATE OF BIRTH______________

PLACE OF BIRTH________________________

Name of a Priest in Cambridge acquainted with the applicant and able to confirm that she is a practising Roman Catholic ______________________________________

Course of study being pursued at Cambridge____________________________

PURPOSE FOR WHICH YOU REQUIRE A GRANT

FINANCIAL SITUATION Please give full details.

DETAILED BREAKDOWN OF THE FINANCIAL COSTS OF YOUR PROPOSAL:

I DECLARE THAT I CONFORM WITH THE CONDITIONS OF THIS TRUST

Signed_______________________________________Date____________________

This form should be sent in an envelope marked “Kolb Application” by your Tutor or Director of Studies together with a reference (which may be written on the last page of this form) to: Mrs Amanda Perreau-Saussine, Fellow and Lecturer in Law, Newnham College, Cambridge. CB3 9DF

REFERENCE ON BEHALF OF __________________________________________

Signature___________________________________ Date ______

Name___________________________

Relationship to Applicant (Tutor/Director of Studies etc.) ______________________