UCL ELIAHOU DANGOOR SCHOLARSHIP
APPLICATION FORM
SCHOLARSHIP ELIGIBILITY CRITERIA
To be eligible to apply for this award, applicants must:

Be a UK domiciled (Home fee paying) student;

Hold an offer of admission to UCL to study a full-time or part-time Undergraduate Degree within a STEM
subject (commencing in September 2012). Please refer to the web site page for this scholarship for a full list
of eligible STEM courses.
SCHOLARSHIP VALUE, TERMS AND CONDITIONS
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The value of the award is £1,000 payable for the first year of the course towards maintenance only (£500 for
p/t study).
The Eliahou Dangoor Scholarship may be held alongside other scholarships, studentships, awards, loans or
bursaries.
The scholarship cannot be transferred to another institution, nor deferred to a later year.
Payment will only be made if the recipient is registered and enrolled for an Undergraduate Degree programme
at UCL.
All funding is subject to the provisions of the General Regulations for Scholarships, Awards, Bursaries, Prizes
and Medals.
For further details and information about this scholarship and other sources of funding, please visit:
www.ucl.ac.uk/scholarships
COMPLETING A SCHOLARSHIP APPLICATION PLEASE READ CAREFULLY AND FOLLOW ADVICE GIVEN
 Your scholarship application must be complete at the date of the deadline in order to be valid. We
are not able to acknowledge receipt of application forms. Incomplete applications are invalid and
will not be processed.
 If you would like to be considered for funding for more than one programme, you should submit
separate scholarship applications (incl. full documentation) for each of the programmes for which
you are seeking funding.
 Please ensure that all information is typed if possible. The presentation and legibility of your
application does matter. If you are unable to type the form and required documents, please explain
why, and make sure you write legibly (print in black ink).
 Please complete all relevant fields. Do not provide information on separate sheets unless the form
asks you to do so.
 Please make sure you include a valid email address on the form.
 Please only send us complete applications (i.e. applications including all required documents). All
applications received by the relevant application date are treated equally; sending your application
early will not increase your chances.
 Please enclose any additional documentation required for your application to be valid. Please do not
enclose any documents not requested.
 If you must send supporting documents separately, then please note this in the application form.
Each document sent separately must be marked “Scholarship Application for <your name>” and
“Scholarships” at the top of each page, including the name of the award for which you are applying.
 Before posting your application to us, please re-read it carefully for accuracy and make sure you
keep a copy of your application for your files.
 If possible, please do not fold your application, but use an A4 envelope to post it to us.
 Please include your scholarship application with your application for admission. Each application
must be sent separately to the relevant sections within UCL.
Only successful applicants and reserve candidates will be notified.
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For further information about eligibility and selection criteria, and other funding schemes, please see
ww.ucl.ac.uk/scholarships
APPLICATION DEADLINE: 24 AUGUST 2012 (4pm)
Applications can be:
Posted to:
Student Funding Office
Registry & Academic Services
University College London
Gower Street
London
WC1E 6BT
UK
Emailed to:
studentfunding@ucl.ac.uk
DO NOT SUBMIT THIS PAGE WITH YOUR APPLICATION
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UCL ELIAHOU DANGOOR SCHOLARSHIP APPLICATION
 Please complete ALL sections, if only by ticking the ‘no’ box, or entering not applicable (n/a).
 By submitting this form and providing any required documentation, you are applying for the UCL Eliahou
Dangoor Scholarship.
PERSONAL DETAILS (please give your surname/family name and first names as they would appear on your
passport)
Surname/Family Name
First Name/s
Title
Choose an item.
Date of Birth dd/mm/yyyy
Nationality
CONTACT DETAILS (If you are successful, we will contact you by email)
Email Address
Mobile Phone
CORRESPONDENCE ADDRESS 1
This is the address to which the official award letter will be sent should your application be successful. You should
inform us should this address change.
Street Address
Postcode
City and Region/County
Country
Telephone inc. STD
How long is this address valid?
From mm/yyyy
To mm/yyyy
UCL STUDY/RESEARCH FOR WHICH SCHOLARSHIP FUNDING IS INTENDED
You must provide proof of the information you give below.
Qualification sought
BA, BSc, BEng, MEng, MSci etc.
Programme/Course Title
(this must be a STEM subject as defined by UCL)
UCL Department/Institute
Method of study
full-time, part-time
Admissions/Enrolment Status in relation to
programme above
Programme Start Date: date of expected or
Choose an item.
Choose an item.
actual first registration /enrolment mm/yyyy
Fees Status (specified in the offer letter)
Choose an item.
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Surname/Family Name
First Name
EDUCATION FROM THE AGE OF 17
Start with current or most recent, and include professional qualifications where appropriate.
Institution Name
Institution
Location
Start
date
(City, Country)
(mm/yyyy)
Graduation Qualification Subject area
Date
achieved (or
(mm/yyyy)
predicted
grades)
(e.g. A Levels,
Baccalaureate,
BA, BSc, MA..)
Your
overall
Grade,
GPA or
Class
Grading
Structure used
state highest and
lowest possible
grades (A – Z, 1 –
6, 0% – 100 %…)
PAST/CURRENT PRIZES, AWARDS AND SCHOLARSHIPS AWARDED
We may request proof (copies of award letters or certificates) of the information you give below.
Name of Prize, Award or Scholarship
Purpose
Overall value in £
Please list only those awarded on the basis of
academic merit/achievement
What was the prize, award or scholarship
awarded for?
if applicable
Date awarded
(mm/yyyy)
as applicable
FUNDING ALREADY SECURED FOR STUDY INTENDED AT UCL FROM SEPTEMBER
Please tell us of any other funding you have secured relating to the intended programme.
Scholarship/Grant Name
Value per
year in £
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Duration
Purpose
Years
(Fees, living costs, equipment, travel, etc.)
Surname/Family Name
First Name
FINANCIAL CIRCUMSTANCES and BACKGROUND – written summary
This Scholarship is intended to provide support to talented students from under-privileged or non-traditional
backgrounds, who may be unable – without a scholarship – to study at UCL. Please give details of your current
financial circumstances and your family background. This should include whether you are the first member of your
family to attend university, or study for higher education qualifications. Also, you may wish to highlight any
unexpected events either financial or personal that have had a direct impact on your studies, or have proved
challenging in your pursuit of obtaining a place at university. All information provided will be treated in the strictest
confidence.
Continue on separate sheet if necessary
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Surname/Family Name
First Name
ADDITIONAL DOCUMENTS: You MUST attach the documents listed below if required for the scholarships
you are eligible for. Without them your application is invalid.
PLEASE NOTE: Documents provided will not be returned.
x
Please indicate in the right-hand column which documents you have enclosed.
Financial Support Notification showing the government support to which you are entitled for 2012/13 (this may
vary depending on whether your assessment is carried out in England, Wales, Scotland or Northern Ireland). A printout of your entitlement confirmation/letter is acceptable.
X
X
X
CONFIDENTIALITY - DATA PROTECTION ACT (1998)
University College London is a data controller in terms of the 1998 legislation. The Student Funding Department (SF) follows UCL policy in
matters of data protection. The data requested in this form is covered by the notification provided by UCL under the Data Protection Act.
Personal data will be used to administer your award as appropriate, and for statistical purposes and electronic records keeping.
The data will not be passed to any other third party without your consent, except when UCL is required to do so by law. Any formal enquiries
concerning the use of data noted here should be addressed to the UCL Data Protection Officer. Once you are happy with your application,
please print the form and date and sign below. Please keep a copy for your files.
APPLICANT’S DECLARATION
By submitting this application to UCL on
(Surname/Family Name), declare that:
(Submission date), I,
(First Name)
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I understand that my application is valid only if all required information is provided and all required
additional documents enclosed;
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the information I have provided is accurate and true to the best of my knowledge;
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I authorise UCL to provide a copy of my application to the funders of the scholarship in the event that
my application should be successful, if required.
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I understand that documents submitted with this application will not be returned to me.
Applications should be submitted by: 24 August 2012 (4pm)
Student Funding,
Registry & Academic Services
University College London
Gower Street
London
WC1E 6BT
United Kingdom
Email: studentfunding@ucl.ac.uk
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