UCL ESRC DTC
MPhil/PhD Application Form
Multidisciplinary Studentships 2013/14
Please complete this form and submit it alongside your CV and cover letter
1. APPLICANT’S DETAILS
1.1 First name: ………..………………………………………………………………………………………...
1.2 Surname: ………..……………………………………………………….…………………………………..
1.3 Date of birth (DD/MM/YYYY): …………………………………………………………………………...
1.4. Nationality: …………………………………………………………………………………………………
1.5 Country of ordinary residence: ….…………………………………………………………………………..
1.6 Country of birth: ……………..….…………………………………………………………………………..
1.7 Is English your first language (please circle)? YES
NO
1.8 If NO, how do you fulfil UCL’s English language proficiency requirement (see www.ucl.ac.uk/prospectivestudents/graduate-study/application/research/english-language)?
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1.9 Fee status (please circle):
HOME
(NB: EU applicants may only be eligible for fees-only funding)
EU
1.10 Proposed mode of study (please circle):
(NB: Part-time is 50% of full-time)
PART-TIME
FULL-TIME
2. EDUCATIONAL HISTORY
2.1 Give details of your undergraduate qualification(s):
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2.2 Have you previously completed one or more Master’s-level course? (Please circle):
YES
NO
If YES, please give details for each Master’s-level course:
2.2.1 Place of study: ………………………………………………………………………………………....
2.2.2 Title of course: ………………………………………………………………………………………..
UCL ESRC DTC
2.2.3 Source of funding: ………………………………………………………………………………….....
2.2.4 Start date (MM/YYYY): …………………...…………………………………………………………
2.2.5 Completion date (MM/YYYY): ………………………………………………………………………
2.3 Are you currently registered for an MPhil/PhD? (Please circle):
YES
NO
If YES, please give details:
2.3.1 Place of study: ………………………………………………………………………………………....
2.3.2 Title of course: ………………………………………………………………………………………..
2.3.3 Source of funding: ………………………………………………………………………………….....
2.3.4 Start date (MM/YYYY): ………….………...…………………………………………………………
2.3.5 Expected completion date (MM/YYYY): ……………………………………………………………
2.4 Have you ever registered for an MPhil/PhD before? (Please circle):
YES
NO
If YES, please give details:
2.4.1 Place of study: ………………………………………………………………………………………....
2.4.2 Title of course: ………………………………………………………………………………………..
2.4.3 Source of funding: ………………………………………………………………………………….....
2.4.4 Start date (MM/YYYY): ………….………...…………………………………………………………
2.4.5 Completion date (MM/YYYY): ………………………………………………………………………
2.4.6 If PhD was not completed, please give details below:
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3. FURTHER INFORMATION
3.1 Details of any relevant prizes or awards:
UCL ESRC DTC
3.2 Brief description of academic and professional record (250 words max):
3.3 Please list any publications/disseminations resulting from your work:
UCL ESRC DTC
4. PhD PLANS
4.1 What attracts you to these studentships (100 words max)?
4.2 Start date:
(NB: The start date of the studentships is 23 September 2013. A later start date is not normally permitted. If
you wish to apply for permission to start later, please give reasons in the space below.)
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4.3 Which of the three possible PhD projects do you prefer?
Project title
1. Improving wellbeing in the
elderly by understanding the
cognitive and neural bases of
healthy ageing
2. Explaining individual
differences in social cognition and
behaviour
3. Developing an understanding
of interventions targeted at healthrelated lifestyle behaviours
Project topic description
The ageing population poses a number of challenges to
society that span social, economic and medical issues. This
project integrates complementary approaches brings together
social science and biomedical approaches to characterise the
behavioural consequences of aging for mental functioning and
the associated neural changes in healthy ageing and age-related
conditions such as Alzheimer’s disease and stroke.
Autistic spectrum disorder compromises the way in which
people relate and communicate with one another. This project
integrates psychological data (behaviour and test performance)
with biomedical data (genetic and neuroimaging markers) to
investigate causes and consequences of individual differences
in social cognition and behaviour.
Certain lifestyle behaviours (such as addiction, smoking and
gambling) and citizenship behaviours (such as blood and
organ donation) are an increasing burden on society. The
project spans brings together recent developments spanning
the social and biomedical sciences pertaining to improving
management of these conditions by examining individual
differences in response to behavioural interventions. Training
will combine social science approaches including
psychological and ‘nudge’ policies to treatment with
biomedical training in the collection and interpretation of
biomarkers.
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UCL ESRC DTC
4.4 Describe a possible research project based on the above project topic descriptions that you wish to pursue
during a PhD (500 words max):
4.5 Do you have specific supervisors in mind (please circle)?
YES
NO
(NB: this is for our information only - applicants are not expected to approach potential supervisors)
If YES, please give details:
Proposed first supervisor(ESRC discipline):
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Proposed second supervisor (MRC discipline):
UCL ESRC DTC
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5. REMIT STATEMENTS
5.1 It is essential that the topic and methodology of your research falls within the remits of the disciplines
involved in the multidisciplinary studentships. Please describe below how your work is consistent with the
remits of the relevant ESRC and MRC disciplines. We would also like you to consider the potential
economic and social impact of your work (250 words max).
5.2 Explain why you are eligible for ESRC funding (100 words max):
(NB: Applicants are normally expected to have a good undergraduate Honours degree and relevant
postgraduate training or experience. Applicants also need to satisfy the ESRC residency requirements. See
http://www.esrc.ac.uk/funding-and-guidance/guidance/postgraduates/prospectivestudents/eligibility/index.aspx for further details.)
UCL ESRC DTC
6. REFEREES
Please give the contact details of two referees who can comment on your ability to pursue PhD studies and
academic research. NB: We may contact your referees as part of the evaluation process of your application.
6.1 Referee 1:
6.1.1 Name: ………………………………………………………………………………………..................
6.1.2 Title: …………………………………………………………………………………………………..
6.1.3 Relationship to you:……………………………………………………………………………………
6.1.4 Postal address: …………………………………………………………………………...………….....
6.1.5 Email address: …………………...………………………………………………………………….…
6.2 Referee 2:
6.2.1 Name: ………………………………………………………………………………………..................
6.2.2 Title: …………………………………………………………………………………………………..
6.2.3 Relationship to you:……………………………………………………………………………………
6.2.4 Postal address: ………………………………………………………………………………….............
6.2.5 Email address: …………………...………………………………………………………………….…
7. DECLARATION
Please note that the UCL ESRC DTC reserves the right to terminate a studentship should it be discovered that
the awarded student has made a false statement, omitted significant information or failed to meet any of the
eligibility criteria.
To the best of my knowledge, the information on this application is accurate and complete.
NAME: …………………………………………………………………………………………………………
SIGNATURE: ………………………………………………………………………………………………….
DATE (DD/MM/YYYY): ……………………………………………………………………………………..