Scholarship Application Form



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PROSPECT BURMA SCHOLARSHIP APPLICATION FORM 2010 FOR NEW APPLICANTS

This form is only for new applicants. If you received a Prospect Burma scholarship for the 2009-2010 academic year and are continuing in the same degree programme, you should complete the shorter form headed Application for Continued Funding. All forms are available on the Scholarship Applications page at www.prospectburma.org

Deadline for submission: 31 March 2010 The following documents must be submitted to the appropriate address listed on the following page:
A completed copy of this Application form;
For applicants in India only: Paste a passport-size colour photo in the box shown on the form

Applications dated after 31 March will not be accepted Submitting your Application Submit all documents by 31 March 2010 to: INDIA Students in India should send hard copies (Email is not acceptable) of their applications and supporting documents to: Ms Lata Pillai Student Information Centre A-Block, Pocket-AG1 141C, Vikaspuri New Delhi-110018 India Tel: +91 981 095 9926 E-mail: [email protected] SOUTH EAST ASIA AND HONG KONG Students in Thailand, Cambodia, Laos, Vietnam, Malaysia, Singapore, Indonesia, the Philippines, and Hong Kong should mail or Email their applications and supporting documents to: Ms Julie Abbot P. O. Box 8 Mae Ping Post Office Chiang Mai 50301 Thailand Tel +66 53 220 067 E-mail: [email protected] ALL OTHER COUNTRIES Students in all other countries should send hard copies (Email is not acceptable) of

their applications and supporting documents to: Scholarships Committee Prospect Burma Porters’ Lodge, Rivermead Court, Ranelagh Gardens, London SW6 3SF United Kingdom

Name

Students In India ste Your Photo Here

University Your Email (print clearly and tell us immediately if you change your email): PROSPECT BURMA

Scholarship Application form 2010 ♦

answer ALL questions fully in English in black ink

♦

APPLICATIONS MUST BE SUBMITTED TO THE ADDRESS SHOWN IN THE GUIDANCE NOTES BY 31 MARCH 2010

♦

We do NOT acknowledge receipt of applications. If you have not heard from us by 31 July, you should assume that your application was unsuccessful

SUMMARY OF YOUR APPLICATION Name:

Date of Birth:

Male/Female:

Ethnic origin

Level of Degree studying for(eg BA, MA etc)

Subject:

Course ends (month/year):

Funding requested (state amount & currency):

FOR OFFICE USE ONLY. DO NOT WRITE ANYTHING BELOW Registered:

New Student:

Yes/No

Previous study report received: Course enrolment confirmed: References: Sent for

Offer of Place: Received

Checked

Scholarship C’tee decision: Applicant short-listed : Final decision:

Reject

□

Accept

□

Yes/No Amount granted:

Successful applicant notified: Grant letter issued:

Returned signed:

Funds transferred on:

Receipt acknowledged:

Notes:

1. YOUR PERSONAL DETAILS

Full Name:

Date of Birth

Aliases (if any):

Place of Birth

Male/Female

Married/Single

Ethnic origin:

No. of Children

Mailing Address:

City:

Post Code:

Telephone: (country code & number)

Country: Fax:

E-Mail:

Details of passport or other travel document: Number: Issuing Authority: Place & Date of issue:

2. PARENTS If either or both parents are retired or deceased, please give their previous occupation Father: Name Country of residence:

Occupation:

Mother: Name Country of residence:

Occupation:

3.

STUDENT STATUS:

Delete one of the following:

Name of university /college:

a) I have applied to: b) I have been accepted for :

Address of your university/college:

Post Code:

Country:

Telephone:

Email:

Name:

Are you currently enrolled in a first degree (undergraduate) course?

YES/NO

If YES, attach documentation confirming that you are registered as a student. Are you currently enrolled on a postgraduate degree course?

YES/NO

If YES, attach documentation confirming that you are registered as a student. Do you have a confirmed offer of a place on a postgraduate degree course?

YES/NO

If YES, attach a copy of the offer.

If you cannot attach all the required documents when submitting your application, please explain the reasons in a covering letter; and send the documents as soon as they are available. Applications without all necessary supporting documents will be rejected. You may attach further documents if you think they will help your application. 4.

DETAILS OF YOUR COURSE:

Title:

Is the course?

FULL TIME PART TIME CORRESPONDENCE (Please delete as appropriate)

Starting Date: (Month/Year)

Expected finishing/graduating date: (Month/Year)

What is your main subject of study? What is the title of your thesis? (If appropriate)

What qualification do you hope to receive from this course, eg BA, BSc, MA, MSc. Ph.D?

Name: 5. PREVIOUS EDUCATION a.

Name & location of Secondary School attended:

b. Subjects studied:

Examinations passed with dates:

c. Details of College/University attendance:

Examinations passed with dates:

d. Details of any formal English language tuition/examinations passed:

6.

REFERENCES

Names and addresses of people who can comment on your academic ability (one of these must be your current or most recent academic supervisor): First Referee Name:

Second Referee Name:

Address:

Address:

Telephone:

Telephone:

Fax:

Fax:

Email:

Email:

Attach at least one written academic reference. If you fail to give the names of ACADEMIC referees, it will delay consideration of your application. Names of friends, other students or relations ARE NOT ACCEPTABLE.

Name: 7. a.

FINANCIAL QUESTIONS EXPENDITURE: How much will your annual academic fees & living expenses be for the academic year 2010-2011 ? Make clear the currency used (US Dollars, Pounds sterling, Thai baht, Indian rupees etc)

Currency Tuition Fees per year Registration fees Books & other materials

Other academic fees (specify) Accommodation Food Local Travel Other expenses (specify)

TOTAL EXPENDITURE

b.

INCOME: Sources of Financial Support for the academic year. Please indicate whether the amounts are assured, or if you have made an application. Include applications to the Open Society Institute (OSI) or other funders.

Source

Details

Applied for? Or Certain?

Amount

Personal savings Funds from parents relatives/other individuals Other scholarships/ grants (if any) Fee Waiver (if any)

Part time work Other (specify) TOTAL INCOME NET FUNDING REQUIRED (total expenditure minus total income) ……………………………

FAILURE TO DISCLOSE ALL OTHER FINANCIAL SUPPORT, GIVEN NOW OR AT A LATER DATE, WILL RESULT IN DISQUALIFICATION

Name: c. Details of your bank account: Name of Bank and full branch address:

SWIFT code:*

Name in which account is held:

Bank clearing code (if any)*:

Account number:

We prefer that you have your own account, but if you use a friend’s account, be sure they agree. *Ask your bank for the codes needed for international bank transfers

Prospect Burma only offers partial awards; how will you cover the rest of your expenses?

8.

BIOGRAPHY:

Give details of your connection with, and dates of residence in Burma and in your present country of residence. Tell us also of your reasons for choosing your course of study.

Name:

9. FUTURE PLANS : This section is very important. The essay must be your own. Candidates submitting identical essays will be disqualified. We will give preference to candidates studying subjects relevant to the development of Burma. Please use this space to tell us in your own words about your future plans, and how you will benefit Burma. Continue on a separate sheet of paper if necessary and sign it.

Signature…………………………………………………………….Date…………………………… If you are awarded a scholarship, we will ask you to sign an undertaking that you firmly intend to return to Burma when feasible to help your country’s development.

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