BLODWEN JERMAN PRIZE DISSERTATION ENTRY FORM
CANDIDATE’S HOME ADDRESS ………………………… …………………………………………………………………... …………………………………………………………………... HIGHER EDUCATION INSTITUTE TO WHICH CANDIDATE IS OR WAS ATTACHED (with Address) ………………………………………………………………….. ………………………………………………………………….. ………………………………………………………………….. ………………………………………………………………….. DEGREE FOR WHICH DISSERTATION WAS SUBMITTED ………………………………………………………………….. DATE DEGREE WAS AWARDED ………………………… TITLE OF DISSERTATION ………………………………. …………………………………………………………………... …………………………………………………………………...
This form should be accompanied by the required certification,
signed and including contactable address. Please return completed application to: Professor Muriel Chamberlain, 22, Wimmerfield Drive,
Killay, Swansea SA2 7BR |
