Student number: to be completed by Registry
Course applied for: to be completed by Registry
Surname: _______________________________________________
First name(s): _______________________________________________
Date of Birth: _______________________________________________
E-mail: _______________________________________________
Criteria and Enclosures Checklist

I enclose, or have submitted separately:

A completed MSc Application form for MSc Public Health at the School:

Two completed MSc Applicant Reference forms

Equal Opportunities Monitoring form

A full official transcript of my studies

A full Curriculum Vitae / résumé
 If awarded the Wellcome Trust Masters Award in the History of Medicine at the
London School of Hygiene & Tropical Medicine, I agree to follow an “historical pathway” through the MSc course – by taking the History & Health module in Term 3 and by writing an historical review or policy report for the Masters dissertation.

I have completed all sections of this form, including the Application Statement and
Outline of Proposed Project.
Applicant signature _______________________ Date ________________
Please ensure that you have also submitted a complete MSc Application (this can be downloaded from www.lshtm.ac.uk/prospectus/howto ). You should return the MSc, application forms and all related documentation to the address below.
Registry, London School of Hygiene & Tropical Medicine, 50 Bedford Square, London WC1B
3DP, United Kingdom. E-mail: registry@lshtm.ac.uk Telephone: +44 (0) 20 7299 4646
Fax: +44 (0) 20 7323 0638

Wellcome Trust Masters Award (History of Medicine) – Application Form 2009-10
Application statement: you should give details of your background in history, history of medicine or other relevant social science discipline, and state why you wish to follow an historical pathway in your degree.

Wellcome Trust Masters Award (History of Medicine) – Application Form 2009-10
Outline of proposed project: Attach a description of your proposed project. This may be either a historical literature review, an original historical research project or a report on an historical subject relevant to current policy (Maximum one A4 page).