Dean’s Academic Excellence Scholarship
Application Form for applicants commencing courses in September 2014
Closing Date: Midnight on Thursday 15 May 2014
To be considered for this scholarship you must have an actual or predicted degree classification of 2.1
or above. You must be either a) UK / EU resident, or b) a current Middlesex University student (UK, EU or
international) or c) a Middlesex alumnus (UK, EU or international). You must have applied to Middlesex
University London campus for a programme of study before this application can be assessed.
Personal Details
Family Name:
First Name:
Previous Name:
Gender:
Date of Birth:
Title
(Mr, Mrs, etc):
Male
Female
Address:
Tel No:
Mobile:
Email:
Middlesex University
I have applied to study the following programme at Middlesex University, commencing
September 2014:
Application Number:
I am (please tick the box that corresponds to you):
A current
Middlesex
student
Middlesex alumnus
Neither a current Middlesex student or
recent alumnus, but I am UK/EU
resident
Name of Previous College/University
Name of Course & Predicted/Actual Degree Classification
Academic Achievement
In not more than 200 words tell us about your academic achievement to date:
Professional Experience
In not more than 200 words tell us about your professional experience to date:
Commendations / Prizes / Awards
In not more than 200 words tell us about any of the above that you have received:
Other information
In not more than 200 words tell us about any other information you feel may be relevant to your
application (e.g. extra-curricular activity, leadership experience, volunteering, mentoring)
Future Vision
In not more than 200 words tell us about your plans for the future and how your intended course of
study will support this vision:
Reference
Please submit a letter of support/recommendation from your University/Employer and attach to this
application. Failure to do this will make your scholarship application ineligible for consideration.
(Written reference MUST be on letter headed paper and attached to application)
Full Name:
Post/Occupation
Relationship To
Applicant:
Address:
Tel No:
Email:
Applicants Declaration
I certify that the above information is correct and I accept that the decision of the Middlesex University
Scholarship Awards Committee is final. Terms and Conditions apply. Furthermore, any statements on this
form which prove to be untrue or purposely misleading will render the application void. If inaccuracies are
highlighted at a later stage we retain the right to retract the scholarship and review your student status.
The University reserves the right to use all or part of your personal statement, quotes, photographs or other
materials for publicity and promotional purposes. I consent to the processing of this data by Middlesex
University under the provision of the 1998 Data Protection Act.
Signed
Please return your completed application to:
Scholarships & Bursary Officer
Middlesex University
The Burroughs, London
NW4 4BT
Telephone: +44 (0)208 411 6286
Fax: +44 (0)208 230 6105
Email: scholarships@mdx.ac.uk
Date