<p>CHARLES WALLACE INDIA TRUST TRANSLATION AND WRITING FELLOWSHIP 2017 AT LITERATURE ACROSS FRONTIERS, ABERYSTWYTH UNIVERSITY, WALES</p><p>APPLICATION FORM</p><p>1 PERSONAL DETAILS</p><p>Surname First Names (in full)</p><p>Title</p><p>Date of Birth (day/month/year) Nationality Sex</p><p>Age </p><p>Passport Number</p><p>Issued On Issued In</p><p>2 CONTACT DETAILS</p><p>Residential Address</p><p>Telephone Number Mobile Number Email</p><p>Correspondence Address if different to above</p><p>3 EDUCATION AND QUALIFICATIONS</p><p>Give details, where obtained and dates</p><p>4 PROFESSIONAL OR OTHER QUALIFICATIONS including other fellowships and scholarships Give details, where obtained, and dates 5 EMPLOYMENT</p><p>Present Occupation</p><p>Name and Address of Employer</p><p>6. LITERARY AND TRANSLATION EXPERIENCE</p><p>Please give details of your literary AND translation experience including Publications </p><p>Have you visited the UK before? If so, for what purpose? Please give details.</p><p>Have you previously applied for a Charles Wallace India Trust grant? If yes, give details.</p><p>What other countries have you visited in your literary and translation career and for what purpose? Please give details.</p><p>7 HEALTH</p><p>Aberystwyth University campus is built with concrete steps and walkways. Residential accommodation for the Fellowship is located in town centre. Please let us know if you have any health or mobility problems which could affect your ability to participate fully in your residency. This will not prejudice your application, but will enable us to plan your visit so that you can obtain the most benefit from your stay with us. </p><p>8 REFERENCES</p><p>Name and title of your two referees</p><p>1) </p><p>2)</p><p>Please send a copy of your application and a Request for Reference form to each referee, and ask them to return the Reference form directly to LAF at [email protected] and to Sian Clement Williams at [email protected] </p><p>9 PREFERRED TERM (tick) late March to late June 2017 mid-September to mid-December 2017</p><p>10 ENCLOSURES</p><p>I attach:  a full CV  a passport-sized photograph Project proposal  Examples of literary and translation work. </p><p>SIGNATURE OF APPLICANT</p><p>DATE </p><p>Your signature confirms that, to the best of your knowledge, the information you have given is correct and complete. The closing date for receipt of applications is MIDNIGHT GMT 27th JANUARY 2017. All applicants will be advised by 13th February 2017. </p>