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					                                     UCL RESEARCH SCHOLARSHIP APPLICATION FORM
                                     PLEASE READ THE RESEARCH SCHOLARSHIP APPLICATION FORM GUIDANCE NOTES BEFORE COMPLETING THE FORM

                                                                                                                                                           FOR OFFICE USE ONLY
 PERSONAL DETAILS
 1. Surname/Family Name (as in passport)                        2. First/Given name (as in passport)                            3. Title                   Database
                                                                                                                                - select -                 Application number
 4. Date of Birth (dd/mm/yyyy)                                  5. Nationality                                                  6. Gender
                                                                                                                                M          F               Date of Receipt

 CONTACT DETAILS
 7. Personal Email Address                          11. Address for Correspondence                                                                         SN
                                                    Line 1
 8. UCL Email Address (if applicable)               Line 2                                                                                                 All supporting
                                                    Line 3                                                                                                 documents
 9. Tel (incl. country code)                        City                                                  Postcode
                                                    Country                                                                                                Eligible         YES     NO

10. Mobile/Cell Phone (incl. country code)          12. Dates when address is valid (dd/mm/yy)
                                                    From:                                                           To:                                    Academic Equivalences
                                                                                                                                                           PhD
 PROGRAMME OF STUDY FOR WHICH SCHOLARSHIP FUNDING IS INTENDED                                                                                              Masters with Dist.
 13. Research Subject Area/Programme Title                                                                                                                 Masters with Merit
                                                                                                                                                           UK First class

 14. UCL Department/Institute                                                        15. UCL Faculty                                                       UK 2.1             2.2
                                                                                                                                                           Nominating Dept
 16. Name of Proposed Principal UCL Supervisor                                       17. Fees Status                    18. Method of Study
                                                                                     - select -                         - select -                         Rank        1      2     3
 19. Proposed Starting Date              20. Qualification Sought                    21. Admissions/Enrolment Status                                       Other Funding
                                                                                     - select -
 Month             Year                  (M.Phil./PhD, EngD, etc)                    (in relation to programme above)



 EDUCATION – qualifications already obtained
 22a. Detail your education since age 17. Start with the most recent qualifications. Where appropriate include professional qualifications.
 Name of College/                    Start date      End date       Qualification       Degree Title: Subjects studied and grades              Overall class/     Grading Scale/
 University/Awarding Body            dd/mm/yy        dd/mm/yy       (e.g. ABA,          obtained (e.g. Economics – 75%, Politics – 70%)        grade/GPA          Range of grades
 (state country if outside the UK)                                  BSc)                                                                       (e.g. 5.5)         (e.g. low 1 – 6 high)




 EDUCATION – qualification currently being taken
 22b. Detail qualifications yet to be awarded. Where appropriate include professional qualifications.
 Name of College/University/         Start date      End date       Qualification       Degree Title: Subjects studied and grades              Expected final     Grading Scale/
 Awarding Body                       dd/mm/yy        dd/mm/yy       (e.g. BA, BSc)      obtained so far                                        class/grade/       Range of grades
 (state country if outside the UK)                                                      (e.g. Economics – 75%, Politics – 70%)                 GPA (e.g. 5.5)     (e.g. low 1 – 6 high)




 TO BE COMPLETED BY NOMINATING UCL DEPARTMENT BEFORE RETURNING TO UCL STUDENT FUNDING OFFICE (The box below must be ticked)
 On behalf of the department I hereby confirm that the information above correctly reflects the documentation provided by the applicant.

 Department Name                                                                     Staff Member Name                                                     Date


 EMPLOYMENT, TRAINING AND WORK EXPERINECE
 23. List your employment relevant to the programme of study or scholarship requirements only.
 Name and Address of Employer                     Start date    End date        Position held and main duties
 (state country if outside the UK)                dd/mm/yy      dd/mm/yy




                                                                                      Page 1 of 6
LIST OF PUBLICATIONS
24. Provide an up-to-date list of publications in clear chronological order with the most recent work first. Please include reports, thesis, dissertations, conference
presentations and work published in the public domain. For books, please provide full title, date of publication and publisher; for articles, include details of the relevant
journals; for publications that have appeared online, state the full web address. (Please do NOT include or enclose publications’ abstracts, summaries or copies).



PAST/CURRENT PRIZES, AWARDS AND SCHOLARSHIPS
25. List only those awarded on the basis of academic merit/achievement. We may request proof (copies of award letters/certificates) of the information you give below.
Name of                         Name of Prize/Award/Scholarship             Total Value     Start date     End date        Purpose
Institution/Awarding Body                                                   (in GBP £)      dd/mm/yy       dd/mm/yy        (e.g. Tuition fees, maintenance)




OTHER FUNDING FOR INTENDED STUDY AT UCL
26. List any funding you intend to apply for and/or have applied for and/or secured relating to the intended programme.
Name of                        Name of                                Value per year Duration        Purpose                             Status               Notification date
Institution/Awarding Body      Prize/Award/Scholarship                (in GBP £)     (in years)      (e.g. Tuition fees, maintenance)                         (if not secured)
                                                                                                                                         - select -
                                                                                                                                         - select -
                                                                                                                                         - select -
                                                                                                                                         - select -


SUPPORTING DOCUMENTS
The documents listed below MUST be attached to this application. Without them your application is invalid.
27. Indicate in the right-hand column which documents you have enclosed. Further information on required documents is provided in the guidance notes.
Research Proposal/Outline (see next page)
Academic Reference 1 (see below the required template 1 – related to the most recently completed studies or intended to complete this academic year)
Academic Reference 2 (see below the required template 2 – related to the current/intended research programme/project at UCL)
Academic Reference 3 (optional)
Photocopies of official college and university degree certificates and transcripts (incl. English translation if in foreign language)
Provided documents will not be returned.

APPLICANT’S DECLARATION
To the best of my knowledge, the information on this application is accurate and complete. I understand that my application is valid only if all required information is
provided and all required supporting documents (which will not be returned to me) enclosed.

I agree to inform the UCL Student Funding Office (studentfunding@ucl.ac.uk) immediately of any other scholarships, grants or awards I am offered or awarded (by an
external sponsor/institution, other offices within UCL or my admitting department) subsequent to submitting this application, and to provide details and proof of their
details if requested. I understand that additional funding awarded from another source may be taken into account in the calculation of any scholarship I may receive.

Data Protection Act 1998: I agree to UCL processing personal data contained on this form or other data which UCL may obtain from me or other people or organisations
while I am applying for funding. I agree to the processing and disclosure of such data for any purposes connected with my studies or my funding while on UCL’s
premises or for any other legitimate purpose, including the compilation of statutory statistical and personal returns that UCL is obliged to make to government or other
agencies.

Signature                                                                                                              Date


Please return this form together with all supporting documents listed above to the UCL Department where you are registered or to which you have
been admitted. Full list of UCL Departments can be obtained on http://www.ucl.ac.uk/departments/a-z/




                                                                                Page 2 of 6
Applicant Full Name


RESEARCH PROPOSAL
Please show your understanding of and interest in the area of research and the project. The selection committee members are not likely to be specialists in your
subject. Please describe clearly – in language understood by academics from any discipline – the aim of your research, the methodology that you will use and the
potential significance of this study to your discipline. (max. one A4 page)
The proposal should be written by yourself, not your supervisor or other Department staff.




                                                                             Page 3 of 6
                                 This reference form is available to be downloaded separately from the scholarship webpage if required.

Applicant Full Name



                                     RESEARCH ACADEMIC REFERENCE FORM 1

1. How long have you known the applicant?                                         2. In what capacity do you know the applicant?


3. The applicant is/was in top                        % of students I have taught throughout my academic career.

4. The applicant is/was in top                        % of students in the current year cohort.

5. Only                     % of students in that year cohort can expect to achieve/achieved approximately the same grades as the applicant.

6. Please comment on the applicant’s research potential, academic performance and achievements, prizes and scholarships won, study/research
skills, relevant personal qualities, motivation, and suitability for the intended programme or research project, as well as his/her career aims and
prospects. Where applicable, explain the grading structure of the qualifications attained and provide information about the distribution of grades
within the cohort of students.
(Please comment below or include a separate signed letter on headed paper. If a separate letter is provided we require the other sections on this form to be completed)




7. Recommendations
        I strongly recommend this applicant for the above scholarship                          I recommend this applicant for the above scholarship
        I do not recommend this applicant for the above scholarship                            I am unable to comment
CONTACT DETAILS
Title                       First name                                                      Last name
Name of Institution                                                                         Address
                                                                                            Line 1
Position                                                                                    Line 2
                                                                                            Line 3
Tel                                                                                         City                                          Postcode
Email                                                                                       Country
Under the terms of the 1998 Data Protection Act, an applicant has the right to access any reference submitted to UCL. Please tick this box if you do not wish the
applicant to have access to this reference.

Signature                                                                                                    Date


Thank you for your co-operation in completing this form. Please enclose the printed version of this form and a letter (if preferred) in an envelope and EITHER
sign across the seal before returning it to the applicant OR send it directly to the UCL Department where the applicant is registered or to which the applicant
has been admitted. Full list of UCL Departments can be obtained on http://www.ucl.ac.uk/departments/a-z/

                                                                              Page 4 of 6
                                 This reference form is available to be downloaded separately from the scholarship webpage if required.

Applicant Full Name



                                     RESEARCH ACADEMIC REFERENCE FORM 2

1. How long have you known the applicant?                                         2. In what capacity do you know the applicant?


If the applicant is a new UCL student and you are not able to comment on applicant’s academic performance please go to section 6b.

3. The applicant was in top                        % of students I have taught throughout my academic career.

4. The applicant was in top                        % of students in the current year cohort.

5. Only                     % of students in that year cohort can expect to achieve approximately the same grade as the applicant.

6a. Please comment on the applicant’s academic performance and achievements, prizes and scholarships won, study/research skills, relevant
personal qualities, motivation, and suitability for the intended programme or research project, as well as his/her career aims and prospects. Where
applicable, explain the grading structure of the qualifications attained and provide information about the distribution of grades within the cohort of
students.
(Please comment below or include a separate signed letter on headed paper. If a separate letter is provided we require the other sections on this form to be completed)




6b. Please comment on the applicant’s research potential and how it will fit into the Department research strategy.
(Please comment below or include a separate signed letter on headed paper. If a separate letter is provided we require the other sections on this form to be completed)




7. Recommendations
        I strongly recommend this applicant for the above scholarship                          I recommend this applicant for the above scholarship
        I do not recommend this applicant for the above scholarship                            I am unable to comment
CONTACT DETAILS
Title                       First name                                                      Last name
Name of Institution                                                                         Address
                                                                                            Line 1
Position                                                                                    Line 2
                                                                                            Line 3
Tel                                                                                         City                                          Postcode
Email                                                                                       Country
Under the terms of the 1998 Data Protection Act, an applicant has the right to access any reference submitted to UCL. Please tick this box if you do not wish the
applicant to have access to this reference.

Signature                                                                                                    Date


Thank you for your co-operation in completing this form. Please enclose the printed version of this form and a letter containing comments for sections 6a and
6b (if preferred) in an envelope and EITHER sign across the seal before returning it to the applicant OR send it directly to the UCL Department where the
applicant is registered or to which the applicant has been admitted. Full list of UCL Departments can be obtained on http://www.ucl.ac.uk/departments/a-z/

                                                                              Page 5 of 6
                                 This reference form is available to be downloaded separately from the scholarship webpage if required.

Applicant Full Name



                                     RESEARCH ACADEMIC REFERENCE FORM 3 (optional)

1. How long have you known the applicant?                                         2. In what capacity do you know the applicant?


3. The applicant is/was in top                        % of students I have taught throughout my academic career.

4. The applicant is/was in top                        % of students in the current year cohort.

5. Only                     % of students in that year cohort can expect to achieve/achieved approximately the same grades as the applicant.

6. Please comment on the applicant’s research potential, academic performance and achievements, prizes and scholarships won, study/research
skills, relevant personal qualities, motivation, and suitability for the intended programme or research project, as well as his/her career aims and
prospects. Where applicable, explain the grading structure of the qualifications attained and provide information about the distribution of grades
within the cohort of students.
(Please comment below or include a separate signed letter on headed paper. If a separate letter is provided we require the other sections on this form to be completed)




7. Recommendations
        I strongly recommend this applicant for the above scholarship                          I recommend this applicant for the above scholarship
        I do not recommend this applicant for the above scholarship                            I am unable to comment
CONTACT DETAILS
Title                       First name                                                      Last name
Name of Institution                                                                         Address
                                                                                            Line 1
Position                                                                                    Line 2
                                                                                            Line 3
Tel                                                                                         City                                          Postcode
Email                                                                                       Country
Under the terms of the 1998 Data Protection Act, an applicant has the right to access any reference submitted to UCL. Please tick this box if you do not wish the
applicant to have access to this reference.

Signature                                                                                                    Date


Thank you for your co-operation in completing this form. Please enclose the printed version of this form and a letter (if preferred) in an envelope and EITHER
sign across the seal before returning it to the applicant OR send it directly to the UCL Department where the applicant is registered or to which the applicant
has been admitted. Full list of UCL Departments can be obtained on http://www.ucl.ac.uk/departments/a-z/

                                                                              Page 6 of 6

				
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