Please
attach
recent
Application for Effat University’s Scholership for Graduate Studies
passport size
photo of
yourself
PART A – PERSONAL INFORMATION
To be completed by the applicant electronically or by clear writing using either black or blue pen ink.
1.
Name of the applicant as it appears in the formal ID (ID Cards for Saudi/Iqama or passport for non-Saudis)
-----------------------------------------------------------------------------------------------------------------------------------------First Name
2.
3.
4.
5.
6.
Middle Name
Date of Birth (DD/MM/YYYY): --------/-------/-------Nationality: --------------------------------------------- ID # ------------------------------------- Type (National Card, Iqama, Passport)
Marital Status  Single
 Married
Postal Address: ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Telephone Numbers: (Home) ---------------------------(Work)--------------------------------(Mobile) --------------------------
7.
Family Name
(Fax) ----------------------------------
Email address: _________________________________________________________________________
Please make sure that the email provided is correct and that you check it regularly.
PART B – STUDENT EDUCATION
8. Study History
Please provide the following information for all completed undergraduate or postgraduate qualifications. List the most recent
qualification first. Certified copies of the diplomas and academic records for qualification listed must be provided with the
Application Form.
Name of Qualification
9.
Name of Academic
Institution
Country of
Institution
Date Completed
GPA
Academic and Research Interests:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Effat Scholarship Application Form
Original to be kept at GS Office – Copies to: Office of Scholarships and Financial Aid , admissions; department of concerned graduate program; office of
the dean of the concerned graduate program.
_____________________________________________________________________________________
PART C
Graduate Program you are applying for:
Program Name____________________________________________________________________________________
 Master level program  PhD level program
 Major course work + Thesis/Dissertation  Minimal course work + Thesis/Dissertation
 College of Business
 College of Engineering
 College of Humanities & Social Sciences
Department: _____________________________________________________________________________________
PLEASE ATTACH THE FOLLOWING WITH YOUR APPLICATION
 1 passport-size photo.
 1 copy of your ID (National Card, Passport or Iqama).
 A letter addressed to Effat University President requesting scholarship from Effat University.
 Completed Application Form to one of Effat’s graduate programs.
PART D
Declaration & Signature
1.
I declare that the information I have submitted with this application is a true and complete record of all academic results I
have achieved at each and every academic institution which I have attended.
2.
I hereby authorize Effat University to make enquires and obtains official records from any academic institution concerning
my current or previous attendance which, in its absolute discretion, it believes are necessary.
3.
I acknowledge that my failure to disclose my true and complete undergraduate academic record may result in my
application being rejected. I further declare that all the information supplied by me is complete, true and correct in every
particular and acknowledge that Effat University may terminate my studies if I have misrepresented my past and/or
present circumstances and that this termination may take place at any stage during the program undertaken.
4.
I declare that I will be able to abide by the Effat University’s policy regarding Payment Plans of Tuition Fees.
5.
I understand that the Effat University reserves the right to inform other academic institutions if any of the material
presented to support my application is found to be false.
6.
All documents submitted become the property of Effat University.
7.
I understand that the Effat University may disclose the personal information I have given in this application form to the
Ministry of Higher Education (MOHE) for revision and compliance assurance purposes.
Name of applicant: ________________________________________________________________________________
Signature:________________________________________________________________________________________
Date: ___________________________________________________________________________________________
Effat Scholarship Application Form
Original to be kept at GS Office – Copies to: Office of Scholarships and Financial Aid , admissions; department of concerned graduate program; office of
the dean of the concerned graduate program.