FOR OFFICE USE ONLY
PERSONAL DETAILS
1. Surname/Family Name (as in passport)
4. Date of Birth (dd/mm/yyyy)
2. First/Given Name (as in passport) 3. Title
5. Nationality
6. Country of Domicile (the country in which you are ordinarily resident. We may request evidence of this.)
CONTACT DETAILS
7. Personal Email Address
11. Address for Correspondence
8. UCL Email Address (if applicable) Line 1
Line 2
9. Tel
(incl. country code)
10. Mobile/Cell Phone (incl. country
code)
Line 3
City
Country
Postcode/Zip
12. Dates when address is valid (dd/mm/yy)
From: To:
PROGRAMME OF STUDY FOR WHICH SCHOLARSHIP FUNDING IS INTENDED
13. Programme/Course Title
Database
Application number
Date of Receipt
SN
All supporting documents
Eligible YES NO
Notes
Eligibility check
US domiciled
EDUCATION – qualifications already obtained and pending
14 . Detail your education since entering Higher Education. Start with the most recent qualifications. Where appropriate include professional qualifications.
Name of College/
University/Awarding Body
(state country if outside the UK)
Start date dd/mm/yy
End date dd/mm/yy
Qualification
(e.g. A levels,
BA, BSc)
Degree Title: Subjects studied and
grades obtained (e.g. Economics – 75%,
Politics – 70%)
Overall class/ grade/GPA
(e.g. 5.5)
EMPLOYMENT, TRAINING AND WORK EXPERIENCE
Grading Scale/
Range of grades
(e.g. low 1 – 6 high)
15 . List last three employers and any previous positions relevant to the programme of study or scholarship requirements.
Name and Address of Employer
(state country if outside the UK)
Start date dd/mm/yy
End date dd/mm/yy
Position held and main duties
PAST/CURRENT PRIZES, AWARDS AND SCHOLARSHIPS
Salary (gross)
16 . 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
Institution/Awarding Body
Name of Prize/Award/Scholarship Total
Value
(in GBP £)
Start date dd/mm/yy
End date dd/mm/yy
Purpose
(e.g. Tuition fees, maintenance)
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OTHER FUNDING FOR INTENDED STUDY AT UCL
17 . List any funding you intend to apply for and/or have applied for and/or have secured for the intended programme (DO NOT INCLUDE THESE AWARDS).
Name of
Institution/Awarding Body
Name of
Prize/Award/Scholarship
Value per
year (in GBP
£)
Duration
(in years)
Purpose
(e.g. Tuition fees, maintenance)
Status Notification date (if not secured)
- select -
- select -
- select -
- select -
FINANCIAL CIRCUMSTANCES
Although this award is given on academic merit, we may consider the financial circumstances of students in order to make a final decision.
18 . FINANCIAL PERSONAL STATEMENT
Please explain why you are applying for financial support from UCL and give full details of your current and expected financial circumstances. You may also include past circumstances which have impacted on your current situation. Please include relevant information about any dependents that are supported by the household income and any exceptional expenditure that falls outside of the above calculations.
This text box will expand. You must include a word count at the top of the statement - 500 words maximum.
Continue on separate sheet if necessary and title this “S18”
19 . ACADEMIC PERSONAL STATEMENT
Please provide us with a statement detailing your academic interests; why you have chosen this programme of study; your interest in studying at
UCL; your educational ambitions and how you think this programme will help with your career goals.
This text box will expand. You must include a word count at the top of the statement - 500 words maximum.
Continue on separate sheet if necessary and title this “S19”
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) are enclosed.
I agree to inform the UCL School of Public Policy (polsci.pg@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 any 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.
Once you have completed your application, please print the form, add the date and sign below. If you are sending this application by email,
you may type your name and date, and email the forms as an attachment. Please note, if sending via email, supporting documentation should be limited to only one extra attachment if at all possible (i.e. all supporting documents to be included in one pdf).
Signature Date
Please return this form together with any supporting documents listed above to UCL School of Public Policy via email
( polsci.pg@ucl.ac.uk
) or, if unable to use email, post it to: UCL FAA scholarship, UCL School of Public Policy, 29/30 Tavistock Square, LONDON WC1H 9QU.
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