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					    Access and Community
    Engagement




UK Undergraduate Scholarships Application Form
2011 entry
All scholarships are open to 2011-entry applicants (existing students cannot be considered) without prior experience
of higher education, who are intending to study full-time for an undergraduate degree and liable for full UK home-rated
tuition fees.
You must undertake a household income assessment through Student Finance England/Northern Ireland/Wales or the SAAS.
Outside interests and accomplishments, academic potential and personal circumstances will also be taken into account by the
judging panels.
The scholarships are limited in number and can be highly competitive so unfortunately meeting the eligibility criteria does not
mean you are guaranteed an award. You can apply for all scholarships where you meet the eligibility criteria and deadline,
however, if you successfully apply for more than one scholarship, so that we can financially assist as many students as possible
you will normally only receive the one of higher value.
Basic eligibility criteria are listed below; for full details please visit www.leeds.ac.uk/yourfinances
Centenary Alumni Scholarship - £1,000 p.a. (deadline 6 May 2011)
    Eligible to receive a UK maintenance grant of at least £711 (household annual income of £40,000 or below)
    Achieve AAA at A2 or equivalent in comparable qualifications (excluding AS results and General Studies). Qualifications
     must be taken in one sitting. If applying before taking final A2 exams, predicted grades will provisionally be used.
Leeds Scholarship - £3,000 p.a. (deadline 10 June 2011)
    Eligible to receive the FULL UK maintenance grant (household annual income of £25,000 or below)
    Part of the first generation in your family to enter higher education
    Not in receipt of any other scholarship or bursary
Eliahou Dangoor Scholarship - £1,000 for level one only (deadline 1 July 2011)
    Eligible to receive a UK maintenance grant of at least £935 (household annual income of £36,600 or below)
    Intending to study a single honours degree course in a relevant STEM (Science, Technology, Engineering and Maths)
     subject. See www.leeds.ac.uk/ace/PS/Dangoor.html for further details.
Jeanette Honan Scholarship - £1,000 p.a. (deadline 1 July 2011)
    Eligible to receive a UK maintenance grant of at least £711 (household annual income of £40,000 or below)
    Be entering in 2011 as a full-time undergraduate in level one on any of the single or joint honours degree courses in French
Myrtle Boultwood Scholarship - £1,500 p.a. (deadline 1 July 2011)
    Intending to study a single-honours degree in one of the following University of Leeds Schools: Fine Art, History of Art and
     Cultural Studies, Humanities or Politics and International Studies
    Eligible to receive the FULL UK maintenance grant (household annual income of £25,000 or below)
Robert Ogden Scholarship - £3,000 p.a. (deadline 1 July 2011)
    Currently living in the Barnsley, Doncaster or Rotherham areas of South Yorkshire
    Eligible to receive the FULL UK maintenance grant (household annual income of £25,000 or below)
    Part of the first generation in your family to enter higher education
    Not in receipt of any other scholarship or bursary
    UK Undergraduate Scholarships Application Form                                                                      (I)
    2011 entry




Advice for form completion
PLEASE READ FULLY BEFORE COMPLETING YOUR FORM
Practicalities:
   Make sure all sections of your form are fully completed. Any forms which have information missing when a deadline
    passes will not be sent to the panel for consideration for an award.
   If short-listed for consideration, your form will be passed to a panel of judges from across the University and University
    Union who will not have access to information such as your UCAS form. Ensure that your application is as legible as
    possible and word-process as many sections as you can. Make sure that all key information can easily be found.
   THE FORM MUST BE COMPLETED IN BLACK INK. It will be photocopied several times and sent to members of the
    panel. Do not fold or staple any part of your form and please ensure that all pages are A4 size. Do not write outside the
    given margins of the page as information here will not be picked up by the copying machine.
   Ensure that the pages of your application form are either all single-sided or all double-sided. Please do not mix the two as it
    makes the form difficult to copy. However, the ‘Further Details’ section, should remain as a separate single-sided sheet.
   Ensure you have used correct postage otherwise delivery could be delayed. It is essential that you obtain a certificate of
    postage; we cannot consider forms received after the deadline where there is no proof it was posted prior to it.
Information required:
   Be as specific as possible when writing about things such as your interests and achievements. For example, do not just
    mention ‘voluntary work’ but state when, where and with whom this was carried out. You will be competing against other
    applicants for an award: plan in advance what you are going to write and be as concise and to-the-point as possible for
    these sections. Your family circumstances will be taken into consideration when the scholarships are awarded. It is very
    important that, where possible, some information is included in Section D. Your application will remain confidential
    between you, the undergraduate scholarships staff and members of the scholarship decision-making panel. Please give as
    much detail as possible about any obstacles or difficulties that you and your family have experienced. In particular, provide
    information about how such issues and events have impacted on you.
   Ensure that you carefully choose the person from your school or place of work who will complete the final part of the form
    on your behalf. Your representative must be someone in a position of responsibility who can comment on your personal
    circumstances as well as your work ethic. To benefit your application, this section MUST be completed by a school/college
    representative if you are currently in study unless you have a compelling reason against this.
   If you have already taken your A2 (or equivalent level 3) exams, please include photocopies of your qualification
    certificates. We do NOT require certificates for AS or GCSE exams already taken.


Form Explanatory Notes:
1. Applicant Information Section 2 ‘School/college attended for GCSEs or equivalent’: please give the name and city of the
   school or college you attended for school-leaver qualifications at approximately age 16 (so if you took re-sits or returned to
   education at a later date, we still need the name of your school for compulsory education up to the age of 16).
2. Applicant Information Section 2 ‘Are you entering in anything other than the normal level one of your undergraduate
   course?’: please only indicate ‘Yes’ here if you are entering in level 0 (foundation year) or if you are by-passing level one
   (normal undergraduate first year) and entering in level 2 or level 3.
3. Confidential Statement of Family Circumstances Section C ‘Please indicate your annual taxable household income
   bracket…’: when calculating your annual household income, please do not include any non-taxable benefits.
4. Confidential Statement of Family Circumstances Section C ‘Please indicate your annual taxable household income bracket
   for the tax year 2009-10 using the tick boxes’: if you have asked Student Finance England/Northern Ireland/Wales or the
   SAAS to assess you on the financial year 2010-11 instead, please include the same details here.
5. Confidential Statement from School/Work Representative Section 2 ‘Details of Achieved or Predicted Grades’: AS level
   information is not relevant here as it is not equivalent to a full level 3 qualification (e.g. A2s). Applicants who are taking full
   level 3 qualifications in 2010/11 should request predicted grades be entered here. Applicants who have already taken full
   level 3 qualifications, and are applying during a gap year for example, should request that achieved grades are entered
   here. We therefore do not require that both the achieved and predicted grades columns should be completed.




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UK Undergraduate Scholarships Application Form                                                                     (I)
2011 entry



                                            APPLICANT INFORMATION

 1. Personal Details
 Surname:                                                     Forename(s):
 Male/Female:                                                         Date of birth:
 Full postal
 address (inc.
 postcode):
 Home phone number:                                                   Mobile number:
 Email:

 2. School and Course Details
 School/college attended for GCSEs or equivalent1:
 Are you participating in an alternate entry or access scheme, e.g. Access to Leeds, CFG0? (Y/N)
 If yes, which scheme?
 Course(s) applied for at the University of Leeds:
 Are you entering in anything other than the normal level one of your undergraduate course 2? (Y/N)

 3. Personal Statement
 In no more than 400 words, please use this space to tell us about :
      Your recent interests, achievements and involvement in activities, both in and out of your school/work environment
      Your passion for the subject you are choosing to study
 Please only use the space provided. You can include information from your UCAS personal statement but do not just
 enclose a copy of this in lieu of completing this section. Note the selection panel does not have access to your UCAS form.




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UK Undergraduate Scholarships Application Form                                                                                (I)
2011 entry



 4. For which scholarships do you wish to be considered? Please tick all which apply.
 Centenary Alumni:              Leeds:              Dangoor:               Honan:               Boultwood:               Ogden:


 5. Employment Details
 Name of Employer                     Nature of Work                   Full/Part-time?         Dates – from            Dates – to




 6. Have you or any close family members had experience of higher education? (Y/N)
 If ‘yes’ please give details including institution name & location, type of qualification and family member’s relationship to you:




 7. Declaration – please read carefully
 I confirm that the information given on this form is true and accurate. If any information is subsequently found to be
 inaccurate, the University reserves the right to terminate any scholarship awarded to me and require the return of
 any money paid.
 I understand:
  - If my course at the University of Leeds does not charge full undergraduate top-up fees (£3,375 in 2011-12), I
      will be ineligible to receive the scholarship.
  - That these scholarships are only available to students undertaking undergraduate study
  - That if I am successful in my application:
           I will be required to help promote the scheme to future applicants through various means which could
       include, but are not limited to, giving interviews to act as case studies in future publicity, and talking to potential
       scholars about the scheme.
           The terms and conditions of the award will require me to adhere to the Code of Conduct of the University of
       Leeds, and to maintain a minimum academic standard.
           My name and course details will be given to the scholarship donor
           The academic school or department to which I have applied for a place will be informed.
 Some of the information you have provided may be used anonymously to help give potential donors an impression
 of the range of applicants and recipients we get for our scholarships. The information will be used in such a way
 that you will not be identifiable at any point. However, if you would be unhappy with us using your data in this
 way, please tick this box: 
 If you are provisionally successful in your application, we may wish to contact you by text message to pass on
 information and send out reminders. This is a completely free service however if you do not wish us to use your
 mobile number in this way, please tick this box: 

 Applicant’s signature:                                                                           Date:


       ENSURE THAT YOUR FULLY-COMPLETED APPLICATION FORM IS RECEIVED BY US IN
         ADVANCE OF THE RELEVANT DEADLINE AS DETAILED ON THE FRONT COVER.


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UK Undergraduate Scholarships Application Form                                                                  (I)
2011 entry



 CONFIDENTIAL STATEMENT OF FAMILY CIRCUMSTANCES – to be completed by the main
                                 wage-earner for the household.
Only to be completed by the applicant if main wage-earner is unable due to language difficulties or a
                      disability, or if the applicant is the main wage earner.

 A.          Personal Details
 Name of applicant:                                                   Date of birth:
 Name of main wage-earner:                                            Phone number:
 Postal address
 (inc. postcode) if
 different to
 applicant:
 Relationship to applicant:

 B.  Please name ALL household members (including parents/carers/partner and family
 members supported by the household income but living as students elsewhere)
               Name                          Relationship to Applicant                   Age             Disabled (Y/N)
 1.                                                APPLICANT
 2.
 3.
 4.
 5.
 6.


 C.          Employment/self-employment
 Please provide an indication of your household income. This will be used to provisionally assess eligibility to be
 considered for a scholarship, therefore if no information is provided here we will be unable to judge whether
 this application is eligible to be put forward for an award.
 The University will be provided with household income assessment data by the Student Loans Company; if
 you have supplied inaccurate information here we reserve the right to withdraw any award made.

 Please indicate whether you expect to receive the full UK Maintenance Grant of £2,906:            Yes         No

 If no , please indicate if you expect to receive a UK Maintenance Grant of at least £711:         Yes         No
                                       3                                                     4
 Please indicate your annual taxable household income bracket for the tax year 2009-10 using the tick boxes
 below:
                                      £0 - £5,000                                         £5,001 - £10,000

                                  £10,001 - £15,000                                              £15,001 - £20,000

                                  £20,001 - £25,000                                              £25,001 - £30,000

                                  £30,001 - £35,000                                              £35,001 - £36,600

                                  £36,601 - £39,305                                              £39,306 - £40,000

                                  £40,001 - £49,305                                              £49,306 and above



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 UK Undergraduate Scholarships Application Form                                                                             (I)
 2011 entry



  D.          Additional Information
  Are there any personal or financial matters that have led to difficulty or hardship in the family? Information provided will be
  used for the scholarship decision-making process but kept confidential and only revealed to scholarships officers and the
  scholarship selection panel. Please give as much detail as you can, but only use the space provided.




If the household does not undertake a financial assessment of income for government loans and grants
   we will be unable to assess the applicant’s eligibility for the scholarship and no award will be made.

  E.          Declaration by Parent/Carer/Partner (or applicant if none of these apply)
 I understand that the application will be considered according to the regulations of the University of Leeds
  Scholarships and that the decision of the Selection Panel or their representatives is final.
 The information given on this form is complete and accurate, to the best of my knowledge and belief, and gives a
  true description of personal circumstances. I agree that the University of Leeds may make any reasonable
  enquiries in connection with this application. I undertake to refund in full immediately any money received if the
  information given is found to be inaccurate.

  Signature:                                                                                     Date:

    Relationship to applicant:

    Return completed forms by the relevant deadline (see below) to: Undergraduate
  Scholarship Applications, University of Leeds, Access and Community Engagement,
                        175 Woodhouse Lane, Leeds LS2 9JT.
6 May 2011 for Centenary Alumni Scholarship Applications
10 June 2011 for Leeds Scholarship Applications
1 July 2011 for Eliahou Dangoor, Jeanette Honan, Myrtle Boultwood and Robert Ogden Scholarship
Applications
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UK Undergraduate Scholarships Application Form                                                           (I)
2011 entry



                CONFIDENTIAL STATEMENT FROM SCHOOL/WORK REPRESENTATIVE
 Please return this form to the applicant in a sealed envelope or send to the address below.
     To aid photocopying, please use black ink and do not staple or fold any part of this form.

 1.          Details of School/College/Workplace
 Name of applicant:                                            Date of birth:
 Applicant phone number or email address:
 Name of school/college/workplace:
 Name of representative:                                        Email address:
 Relationship to applicant:                                     Job title:
 School/college/
 workplace address:



 2.      Details of achieved or predicted grades for all A2 or equivalent qualifications (i.e. full level 3
 qualifications) taken by the applicant in further education (predicted grades are not required if full
 A2 results have been achieved)5.
 It is essential that this section is completed.
   Qualification (e.g. A2, BTEC, AVCE) and Subject    Grade Achieved    OR      Grade Predicted   Exam Month/Year




 3.          Applicant evaluation – to be completed by the school/college/workplace representative ONLY.
 Please rate the applicant in the following areas:

                                                     Low           Average            Good           Excellent

 Attendance:

 Reliability:

 General effort shown:

 Attitude to school/college/work:

 Suitability for Higher Education:

 Signature:                                                                          Date:




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 UK Undergraduate Scholarships Application Form                                                                             (I)
 2011 entry




  4.          Additional Information – to be completed by a school/college/workplace representative ONLY.
  Please include here any additional information you would like to give us about the candidate, in particular any relating to personal
  circumstances.
  THIS SECTION IS VERY IMPORTANT AND INFORMATION PROVIDED HERE WILL BE USED AS A DECIDING FACTOR
  WHEN AWARDING THE SCHOLARSHIPS. Please therefore provide as much information as you can about any relevant social,
  financial or other factors that should be drawn to the attention of the selection panel (for example, illness of applicant or family
  members, disrupted schooling, family break-up, unemployment). Continue on another sheet if necessary.




  Signature:                                                                                       Date:



                                     Thank you for your supporting statements.

  Please return this form to the applicant in a sealed envelope or send to the address below.
     To aid photocopying, do not staple (and where possible, do not fold) any part of this form.

This form should be returned to:                                              For further information about all matters
Undergraduate Scholarship Applications                                        relating to undergraduate scholarships contact:
University of Leeds                                                           The Scholarships Team, Access and
Access and Community Engagement                                               Community Engagement
175 Woodhouse Lane                                                            Tel. 0113 343 3378
Leeds
                                                                              Email: ugscholarships@leeds.ac.uk
LS2 9JT

APPLICATION FORMS WILL NOT BE CONSIDERED IF THEY ARE RETURNED AFTER THE DEADLINE(S)
           OR REMAIN INCOMPLETE WHEN THE RELEVANT DEADLINE HAS PASSED:
6 May 2011 for Centenary Alumni Scholarship Applications
10 June 2011 for Leeds Scholarship Applications
1 July 2011 for Eliahou Dangoor, Jeanette Honan, Myrtle Boultwood and Robert Ogden Scholarship
Applications


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UK Undergraduate Scholarships Application Form                                                                             (I)
2011 entry




  Further Details – to be completed by the applicant
  Purely for monitoring purposes, the University of Leeds has adopted a scheme recommended by the
  Commission for Racial Equality. Your ethnic origin will have absolutely no bearing on your suitability and
  selection for the scholarship. Please tick the box that you feel most accurately describes your ethnic
  origin.
  Ethnic Group
  White – British                                         Chinese
  White – Irish                                           Other Asian background
  White – Scottish                                        Mixed White and Black Caribbean
  Other White background                                  Mixed White and Black African
  Black or Black British – Caribbean                      Mixed White and Asian
  Black or Black British – African                        Other Mixed background
  Other Black background                                  Other Ethnic background
  Asian or Asian British – Indian                         Not known
  Asian or Asian British – Pakistani                      Information refused
  Asian or Asian British – Bangladeshi
  Disability (please tick):
                Yes:                                            No:                         Prefer not to say:

  How did you hear about scholarships at the University of Leeds? Tick all that apply
  School talk                                                           Other website (please state)
  Poster/information displayed at school                                Other source (please state)
  University of Leeds website


  Declaration
 I understand that the application will be considered according to the regulations of the University of Leeds scholarships and that
   the decision of the Selection Panel or their representatives is final.
 I certify that the statements made in connection with this application are, to the best of my knowledge and belief, correct and
   give a true and complete description of my financial situation. I agree that the University may make enquiries they think
   appropriate in connection with this application.

  Applicant’s signature:                                                                          Date:


  Return this form to: Undergraduate Scholarship Applications, University of Leeds, Access
             and Community Engagement, 175 Woodhouse Lane, Leeds LS2 9JT

 Please note that confirmation of receipt of your application form will
 be sent out by email only. To receive this, ensure that a legible email
       address is included on the front of this application form.
                DO NOT FOLD OR STAPLE ANY PART OF THIS FORM




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