Nigerian Ambassador
Scholarship
OFFICE USE ONLY:
Applicant number:
Date received (dd/mm/yy):
Notes for applicants



To complete the form, enter text in the grey boxes or click in the check boxes (
) provided. You will not be able to edit any other part of the
form. Forms must be completed electronically and e-mailed to int.app@uwl.ac.uk.
Details entered onto this form will be transferred to a computer. This information will be treated confidentially in accordance with the Data
Protection Act, 1998.
Please use BLOCK CAPITAL letters when completing this form.
SECTION 1
Your choice of course
Name of course (including award title e.g. BSc or MA):
If you are applying for advanced entry (APL) to one our undergraduate courses please indicate proposed year: Yr1
Please indicate your proposed start date:
09/2014
Yr2
Yr3
(MM / YYYY)
Personal
Title (eg Ms/Mrs/Mr/Dr):
Surname (as it appears on your passport):
First name(s) (as it appears on your passport):
Previous surname (if changed):
Gender:
Male
Female
Date of birth (DD / MM / YYYY)
/
/
Home address in country of origin:
Post code/Post Box:
Telephone:
Home:
Mobile:
E-mail:
Nationality:
Nigerian
Country of birth:
Country of domicile or permanent residence:
If you are currently residing in the UK, please provide your UK home address:
Home address:
Post code:
Telephone:
Home:
Mobile:
Agent Details
Name of education agency
Contact Person
Address
Email
Telephone
Stamp
Page 1 of 6
Immigration details (must be completed by all applicants)
Passport number:
Passport issue date:
/
/
(DD / MM / YYYY)
Passport expiry date:
/
/
(DD / MM / YYYY)
Have you previously applied for a TIER 4 General Student Visa and been refused?
Yes
If yes, please provide full details of the reason for your visa refusal and attach copies of the visa refusal documents.
No
Are you currently or have previously been in the UK or other EU member state (excluding tourism purposes)?
Yes
No
If you have answered YES please complete below if NO, please proceed to Section 2
Please state:
- date of first entry to the UK:
- date of most recent entry to the UK:
/
/
/
/
(DD / MM / YYYY)
(DD / MM / YYYY)
Date from which you have been granted:
- exceptional leave to remain in the UK:
- full refugee status in the UK:
- indefinite leave to remain in the UK:
/
/
/
/
/
/
(DD / MM / YYYY)
(DD / MM / YYYY)
(DD / MM / YYYY)
Date on which your student visa was issued (if applicable):
- Institution (eg University of West London):
/
/
(DD / MM / YYYY)
Date on which your non-student visa was issued:
- Please state what type of visa:
/
/
(DD / MM / YYYY)
Date on which your visa expires:
/
/
(DD / MM / YYYY)
Are you currently studying in the UK?
- If yes, please supply the:
- name of institution:
- address of institution:
- level of study:
Yes
No
Foundation
Undergraduate
Postgraduate
English Course
SECTION 2
Current and previous education
Please list all subjects taken, whatever the result, starting with the most recent. If you are awaiting the result of any examination, please write
‘pending’ in the result/grade column. You should also include any recent training and professional development and all music grade/diploma
qualifications.
Name of Institution
(eg: University of West London)
Course title
Awarding body
and
country
Result / grade
Start date
(MM / YYYY)
End date
(MM / YYYY)
/
/
/
/
/
/
/
/
/
/
Please provide details of your highest English language qualification:
Name of English language test
(IELTS, TOEFL, Pearson, etc)
Date taken
Results / scores
Overall
/
/
Reading
Writing
Listening
Speaking
(DD / MM / YYYY)
Page 2 of 6
UK education record
In order for us to issue you with a CAS (Confirmation of Acceptance of Studies), please complete the following details. This is essential in order for
your application to comply with UK Border Agency requirements.
Details of ALL previous courses you
have studied in the UK
(Please include course title and level)
Immigration
status during
the course
(i.e. Tier 4 or
Student Leave)
Start date
(DD / MM / YYYY)
End date
(DD / MM / YYYY)
Qualification awarded?
(Please also give details of
award)
/
/
/
/
Yes
No
/
/
/
/
Yes
No
/
/
/
/
Yes
No
/
/
/
/
Yes
No
/
/
/
/
Yes
No
/
/
/
/
Yes
No
/
/
/
/
Yes
No
/
/
/
/
Yes
No
Membership of professional organisations
Please include membership of any professional body or organisation (please give your registration number where relevant).
SECTION 3
Current and previous employment
Please outline any work experience you have had (both paid and unpaid). Please include details of any special responsibilities. Continue on a
separate sheet if necessary.
Job title:
Name of organisation:
Dates:
From
/
(MM / YYYY) to
/
(MM / YYYY)
From
/
(MM / YYYY) to
/
(MM / YYYY)
Duties
Job title:
Name of organisation:
Dates:
Duties
Page 3 of 6
Personal Statement
Please use this section of the form to provide information to support your application, concentrating on your reason(s) for wishing to take the course
of study and the benefits you expect to gain from it. Please continue on a separate sheet if necessary.
Page 4 of 6
What do you consider to be the advantages of studying at the University of West London? (Approx. 500 words)
Page 5 of 6
Please give three reasons why you consider yourself to be a worthwhile candidate who should receive the scholarship.
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SECTION 4
Equal Opportunities
Please note that this section of the form will be detached before your application is considered.
We would encourage you to give information about your disability to the University so that we can endeavour to make reasonable adjustments for
you. This information will only be available to Admissions and Disability staff and will not be made available to anyone else without your explicit
permission.
Surname (family name)*:
Date of birth:
/
/
(DD / MM / YYYY)
*Please use exactly the same format of your surname as you have used in Section 1 of this form.
Ethnic origin
11
The University is committed to the pursuit
of equality and social justice and has a
policy of equal opportunities. Please help
us to evaluate the effectiveness of this
policy.
12
13
14
19
21
22
Please indicate which you feel best
reflects your ethnic origin.
29
31
32
White (British)
White (Irish)
White (Scottish)
Irish Traveller
Other white background
Black or Black British – Caribbean
Black or Black British – African
Black other
Asian or Asian British – Indian
Asian or Asian British – Pakistani
33
34
39
41
42
43
49
80
98
Asian or Asian British – Bangladeshi
Chinese
Asian other
White & Black – Caribbean
White & Black – African
White & Asian
Other mixed background
Other ethnic background
Information refused
Disability
00
The University of West London welcomes
and supports students with learning
difficulties and disabilities.
To help us to provide appropriate support
services, please indicate which term is
descriptive of your disability.
01
02
03
04
09
05
No disability
Require personal care support
06
Dyslexia
Mental health difficulties
07
Blind/partially sighted
Unseen disability eg diabetes, asthma
08
Deaf/hearing impairment
Multiple disabilities
10
Wheelchair user/mobility disability
Autistic Spectrum Disorder
A disability or special need not listed above (please specify)
Please indicate any support that we can
provide to help you in your studies or
examinations.
Criminal conviction(s)
This part of the form MUST be completed.
If you do not tick either the ‘yes’ or ‘no’ box, we will not process your application. In such circumstances, we will contact you to get the information,
but this will delay your application.
Do you have any criminal conviction(s)?
Yes
No
You must tick the ‘yes’ box if you have a conviction, NOT including:

a motoring offence that you received a fine or three penalty points for; OR

a spent sentence (as defined by the Rehabilitation of Offenders Act 1974), except for certain courses. Please be aware that for certain
courses, particularly in teaching, health, social work and other courses involving work with children, you must tell us about ANY
criminal conviction(s), including spent sentences and cautions.
SECTION 5
References
We require two references as part of your
application. Please supply details of your
referees here and send your reference
letters with this application form.
Reference 1
Name:
Position:
Address:
Wherever possible, one referee should
relate to your current or recent work, and
one to any current or recent study.
Postcode:
Daytime telephone number (including country code):
E-mail:
Reference 2
Name:
Position:
Address:
Postcode:
Daytime telephone number (including country code):
E-mail:
Page 7 of 6
Declaration
To the best of my knowledge, the information I have given on this form is correct.
I declare that the information supplied in my UK education record (in section 3 of this form) is accurate, and I understand that failure to provide the
correct information can lead to the withdrawal of my Tier 4 sponsorship provided by the University.
I recognise that it is my responsibility to ensure that I meet the requirements to make a valid Tier 4 visa application. I am aware that I must comply
with the conditions attached to my Tier 4 leave.
I hereby confirm that I authorise The University of West London to release any personal information regarding my immigration status or immigration
history to the Home Office. I also authorise the Home Office to release any information regarding my immigration status or immigration history to
The University of West London.
Signature of applicant (simply type your name if completing this form on a computer):
Date:
/
/
(DD / MM / YYYY)
Important notes for applicants
Please note that in order for us to consider your application, you must provide us with the following items when you submit this application form:
Copies of certificates and transcripts for your qualifications (including for English language qualifications)
A copy of your passport (both the cover and photograph pages are required) and current UK visa (if any)
2 Recommendation letters for Postgraduate applicants and 1 for Undergraduate
Portfolio; if you are applying for Music or Art & Design related course.
Your completed application form and the documents above can be sent by e-mail to int.app@uwl.ac.uk. Please insert ‘Nigerian Ambassador
Scholarship’ in subject box of your email.
Once we receive your application, we will carefully consider your qualifications and experience, and subsequently we will contact you to notify you
whether or not you have been shortlisted for the scholarship.
If we offer you a scholarship, please respond as soon as possible. If we have offered you a scholarship based on you meeting specified conditions,
you will need to meet these conditions before your scholarship is confirmed.
Please send applications by post or by email to the international office.
University of West London
International Office
St Mary’s Road
Ealing
London, W5 5RF
E-mail: int.app@uwl.ac.uk
www.uwl.ac.uk
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