2012V ACO lgaLopukhovaScholarshipApplication by juobth

VIEWS: 4 PAGES: 5

									                                                                         V-A-C -The Art of being
                                                              Contemporary: The Olga Lopukhova
                                                                                    Scholarship
                                                                                     Application form 2012/13

Deadline

Monday, 02 April 2012

The Committee will consider your scholarship application form in conjunction with your academic application materials.
The majority of scholarships are awarded on academic merit.

                                           PART I: PERSONAL DETAILS

1: Name                                                               2: Contact address
Title: -
Forename(s):
Surname:
Previous name (if any):
Nationality:                                                          Postcode:
Were you born in Russia? Yes        No                                Country:
Are you normally resident/active in Russia? Yes         No            Tel:
                                                                      E-mail:

                                            PART 2: COURSE DETAILS
Name of course:                                                      Name of course tutor:
Is your offer conditional or unconditional? :      Conditional     Unconditional

                                      PART 3: EXPENDITURE FOR THE YEAR

1: INCOME                                                                       2: EXISTING DEBTS
Other scholarships/ grants        £                               Loans           £
Savings                           £                               Overdraft       £
Loans/overdraft applied for       £                               Total           £
Parental/spouse contribution      £

Is one or more of your parents    Yes     No
deceased?

Total                             £                               3: ESTIMATED COST OF ATTENDANCE p.a :
                                                                  £

                                        PART 4: FUNDING APPLICATIONS

Previous funding

Have you ever received funding from the ORS, AHRC or Courtauld Scholarships? If yes, please provide details of the
award, duration and the total amount in the box below.




Other applications for funding (Please give details of any scholarship applications you have made through other
institutions and the date when you expect to receive a decision).
                                        PART 5: PERSONAL STATEMENT

 In no more than 500 words please provide your case for support. In presenting your case you should include:
       The reasons for undertaking your course at The Courtauld
       Please explain in particular your strong interest in Russian contemporary art (note: this scholarship is intended
         to support a student particularly interested in contemporary Russian art)
       How you expect to make a significant contribution to Russian art or this area of study on completion of your
         studies
       Any relevant preparation and previous work or academic experience




Declaration: The information which I have given is true and correct to the best of my knowledge.

             Signature:                                                          Date:


Please return the completed form to: Jonathan Gabony, Courtauld Institute of Art, London, WC2R 0RN or
jonathan.gabony@courtauld.ac.uk
 Our scholarships are awarded on the basis of academic merit, but a few scholarships are specifically for those in
 financial need. If your attendance at The Courtauld Institute of Art is reliant on receiving support for funding, please
 outline any relevant financial or personal circumstances that you believe the Scholarship Committee should consider
 (max 200 words).




References:

 Name, Title and Address
 of first referee:



 Please tick the box if you wish to use the same reference provided in your programme application?

 Name, Title and Address
 of second referee:



 Please tick the box if you wish to use the same reference provided in your programme application?




 Declaration: The information which I have given above is true and correct to the best of my knowledge.


 Student signature:                                                           Date:



Please return the completed form to: Jonathan Gabony, Courtauld Institute of Art, London, WC2R 0RN or
jonathan.gabony@courtauld.ac.uk
First referee:

 Name:

 Title:

 University/
 Institution:

Is the applicant likely to make original and significant contributions to his/her field?
Very likely       Likely           Possibly          Unlikely        (please circle)

In a statement not exceeding the text box below please provide a reference that gives a realistic assessment of the
quality of the applicant’s academic work and performance to date. Please also comment on the applicant’s preparedness
to undertake the proposed course and the likelihood of the applicant completing successfully.




 Signature:                                                                     Date:


Please return the completed form to: Jonathan Gabony, Courtauld Institute of Art, London, WC2R 0RN or
jonathan.gabony@courtauld.ac.uk
Second referee:

 Name:

 Title:

 University/
 Institution:

Is the applicant likely to make original and significant contributions to his/her field?
Very likely       Likely           Possibly          Unlikely        (please circle)

In a statement not exceeding the text box below please provide a reference that gives a realistic assessment of the
quality of the applicant’s academic work and performance to date. Please also comment on the applicant’s preparedness
to undertake the proposed course and the likelihood of the applicant completing successfully.




 Signature:                                                                     Date:

Please return the completed form to: Jonathan Gabony, Courtauld Institute of Art, London, WC2R 0RN or
jonathan.gabony@courtauld.ac.uk

								
To top