Scholarship Application form 2016/17
Once complete, please email this form (and any supporting documents) to: pgadmissions@courtauld.ac.uk
1. PERSONAL DETAILS
Title:
2. CONTACT DETAILS
Choose an item.
Address Line 1:
Surname/Family Name:
Address Line 2:
First/Given Name:
Address Line 3:
Date of birth:
Click here to enter a date.
City:
Gender:
Postcode/Zip:
Nationality:
Country:
Country of Domicile:
E-mail:
Telephone:
3. COURSE DETAILS
NEW Students:
Please select the course
programme(s) you have
applied to:
☐ MA History of Art
☐ MA Curating the Art
Museum
☐ MA Buddhist Art:
History and Conservation
☐ Postgraduate Diploma in
the Conservation of Easel
Painting
☐ MA in
Conservation of
Wall Paintings
☐ MPhil/Research
CONTINUING Conservation
and Research students:
Please select your current
programme of study
☐ Postgraduate Diploma in
the Conservation of Easel
Painting
☐ MPhil/Research
Year of study in 2015/6:
☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5 ☐ 6 ☐ Writing-up year
Course tutor:
4. CURRENT FUNDING / OTHER FUNDING APPLICATIONS
Please provide details of any applications you have made through other institutions and the date by which you expect to
receive a funding decision (this will not influence any decision made on your application at The Courtauld).
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5. EXISTING FINANCIAL COMMITMENTS
Please outline your existing commitments and the total amount owed to date
Student/Career Development Loan
£
Credit Cards
£
Bank Loans/overdrafts
£
Mortgage payments
£
Other
£
Total
£
Please specify:
6. TUITION FEE INCOME
Fee status:
☐ UK
☐ EU
☐ Overseas
Please indicate how you expect to meet the costs of your tuition fees. Please select all that apply:
☐ Self
☐ Federal Loans / Career Development Loans
☐ Partner / Spouse
☐ Scholarships / Grants
☐ Parents / Family contributions
☐ Other (please specify):
7. FINANCIAL CIRCUMSTANCES
Please inform us of both your financial situation for the full academic year preceding your scholarship application
(2015/6), and your expected financial situation during the full academic year of your scholarship application (2016/7).
Annual Income
2015/6
Professional/Career Development Loan
Other Loans (Bank, Family, Employer)
Employment (Part/Full Time)
Scholarship/Bursary
£
£
£
£
Expected
Income for
2016/7
£
£
£
£
Family/Partner Contribution
Savings
Benefits
£
£
£
£
£
£
Other (Please specify in Additional
Comments below)
£
£
TOTAL
£
£
Annual Expenditure
Tuition Fees
Rent/Mortgage
Utilities
Travel (incl. study related
travel)
Food / Social Costs
Debt
Medical Expenses
(insurance etc.)
Other (Please specify in
Additional Comments
below)
TOTAL
2015/6
£
£
£
£
Expected
Expenditure
for 2016/7
£
£
£
£
£
£
£
£
£
£
£
£
£
£
Do you have any financial dependants?
☐ Yes - Please give details:
☐ No
8. AMOUNT REQUESTED
Please state the minimum amount required to ease your financial circumstances: £
Please Note: Your scholarship application is separate to your programme application. It has no bearing on
whether or not you are successful in securing a place on a programme, and as such you are encouraged to put
the full amount that you require.
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9. BANK SAVINGS
You must declare all your bank/building society accounts below. You must supply copies of your last three months of
bank statements relating to each bank account below (mini statements are not acceptable). Please submit scanned
photocopies as we cannot return any original documents that are sent to us. Please explain by annotation any debits or
credits of over £100 that appear on your statements.
1.
Name of bank/building society
Overdraft Limit
Current balance
2.
Type of account
(e.g. student, saving, current)
Name of bank/building society
Current balance
3.
Type of account
(e.g. student, saving, current)
Name of bank/building society
Type of account
(e.g. student, saving, current)
Current balance
Overdraft Limit
Overdraft Limit
If you need to continue on separate sheet, please add it to the end of this form.
10. ADDITIONAL COMMENTS
Please use this space to provide any additional information, or to clarify any of the information or documentation you have
provided as part of this scholarship application.
11. Declaration
I confirm that all the information given in this form is correct and complete to the best of my knowledge. I understand that
providing false information will cause my application to be disqualified.
Signature:
Date:
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Click here to enter a date.
COURSE TUTOR RECOMMENDATION (MULTI-YEAR PROGRAMME CONTINUING STUDENTS ONLY)
To be completed by your course tutor.
Name of student
Course
Name of Course tutor
The above student has applied for a scholarship. I would be grateful if you could provide a statement of support for the
student’s application and to also confirm that the student is attending class/meetings regularly and showing academic
effort.
Signature:
Date:
Course tutors: please return this reference to: pgadmissions@courtauld.ac.uk
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Student checklist
☐
Student Loan Company Schedule letter of accrued debt (if applicable)
☐
Copy of Career Development Loan agreement (if applicable)
☐
3 months of Bank / Building Society statements for all accounts
☐
3 months of Credit Card statements
☐
Evidence of Rent / Mortgage
☐
Evidence of benefits claimed
☐
Course tutor recommendation (Continuing students only)
Please submit photocopies only, as originals cannot be returned.
Please email this form (and any supporting documents) to:
pgadmissions@courtauld.ac.uk
Scholarship applications received after the deadlines indicated on the website will not be considered.
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