Wellcome Trust Masters Award
(History of Medicine)
2016-17 Scholarship
Initial Application Form
This form should be completed by candidates applying for Wellcome Trust Masters Award (History
of Medicine) via the London School of Hygiene & Tropical Medicine for September 2016 entry.
The details you provide on this form will be used to check that you are qualified to apply for this
award. Before completing this form please carefully read the details noted in the advert for this
funding found here.
Notes of Guidance
At this stage please submit your completed Initial Application Form and a CV with a clear description
of your prior education and grades obtained. Please also provide any transcripts you may have for
previous or ongoing qualifications.
In addition, please complete and submit a separate LSHTM study application using the online
application process. The link to the online application can be found under the ‘How to Apply’ tab on
every MSc course page.
Only applicants for the following MSc courses are eligible to complete this Initial Scholarship
Application:
- MSc Health Policy, Planning & Finance
- MSc Nutrition for Global Health
- MSc Public Health
- MSc Public Health for Development
Please note that no other MSc courses offered by the London School of Hygiene & Tropical Medicine
meet the eligibility criteria for this funding.
This Initial Scholarships Application Form is not the final application form, but will provide the initial
details which we will use to screen applications. The subpanel will also expect to consult references
submitted with the LSHTM study application prior to making an offer. The final Wellcome Trust
application form will need to be completed by the successful candidate following discussions with
academic staff at the School in mid- to late-April.
The deadline for this Scholarships Application Form is Monday 4 April 2016.
APPLICATION
1. Your contact details
Title
First name(s)
Last or Family Name
Correspondence
address
Telephone number(s)
Email address
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2.
Residential details
Place of birth (town and country)
Nationality
Country in which you are ordinarily resident
Have you lived in the United Kingdom (England,
Scotland, Wales, Northern Ireland) all of your life?
If NO, please give the last date you entered the UK
(excluding holidays) and state the reason
Do you have permanent right of residence in the UK
and/or EU?
If no, do any of your family members have permanent
right of residence in the UK and/or EU?
YES / NO
YES / NO
3. MSc Course Application
Please note that your funding application will not be processed further if you have not completed an
online study application for one of the London-based courses listed below and submitted this,
together with all the necessary supporting documents, by the Scholarship deadline.
Please indicate which course you have applied for. If you applied for more than one MSc course
when submitting the LSHTM Study Application online please indicate your first course choice.
MSc Health Policy, Planning & Financing
MSc Course
(please indicate )
MSc Nutrition for Global Health
MSc Public Health
MSc Public Health for Development
4. Qualifications
Please provide details of the course or degree which you are currently undertaking, if applicable.
Qualification and
full degree title
Institution
attended
Name of
country
if overseas
FROM
month
and
year
TO
month
and
year
Fulltime
or
Parttime
Anticip
ated
result
Due date
of result
Source of
funding
Self/grant,
etc
Please provide an indication of relevant courses/modules taken and grades received below; or
provide a scanned copy of the interim transcript with this application, if available.
Course
Grade
2
Please provide details of any study (undergraduate, postgraduate and professional) for which you
have already been awarded, starting with the most recent.
Qualification and
full degree title
Institution
attended
Name of
country
if overseas
FROM
month
and
year
TO
month
and
year
Fulltime
or
Parttime
Result (pass/fail)
Please also indicate
class, division or
percentage
Source of
funding
self/grant,
etc
Please list relevant courses/modules taken and grades received below, or submit a scanned
copy of a transcript for each award with this application, if available.
Course
Grade
5. Your employment
Please provide details of work history for the last three years including all periods of employment
and unemployment. A full, detailed study & employment history should be shown on your CV.
Name and
country of
employer
Post held, with brief details of
work and responsibilities
FROM
month
and
year
TO
month
and
year
Fulltime
or
Parttime
Permanent
or
Temporary
Contract
6. Application Statement
Please provide details of your background in history, history of medicine or other relevant
social science discipline, and state why you wish to follow an historical pathway in your degree.
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7. Outline of proposed project
Please provide a description of your proposed project below. This may be either an historical
literature review, an original historical research project, or a report on an historical subject
relevant to current policy (Maximum: 1,500 words or one A4 page)
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8. Declaration
If I am successful in gaining a scholarship
 I give consent for the School and its scholarship partners to announce my name and the
award, and to use photographic images of me, in their publications and websites.
 I also consent to write a 250 word student profile for use in publications
 I consent to my application form being released to the scholarship subpanel
 If awarded the Wellcome Trust Masters Award in the History of Medicine at the London
School of Hygiene & Tropical Medicine, I agree to follow a ‘historical pathway’ through the
MSc course – by taking the History & Health module and by writing a historical review or
policy report for the Masters dissertation
Signature ________________________________________________________________ Date ___________________
This declaration must be signed by hand. Typed signatures will not be accepted.
This completed form must be submitted to the Scholarships Administrator by email to
Scholarships@lshtm.ac.uk no later than Monday 4 April 2016.
Registry, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT
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