Simpson Scholarship Submission Form Please complete all sections of this form – incomplete submissions will not be accepted. Your completed submission form, essay and references should be emailed to simpsonscholarship@accaglobal.com – the next submission deadline is 1 May 2015. You must ensure that you meet three of the following criteria before submitting your application for a scholarship (click on the boxes to confirm): I am registered as an ACCA Qualification student. All fees due up to 1 May 2015 have been paid in full – including my 2014 annual subscription (if applicable). I have completed the Knowledge module of the Fundamentals level of the ACCA Qualification and have achieved an average mark of 80% or over – at my first attempt. or I was awarded exemptions for the Knowledge module papers and have sat and achieved 66% or over for at least two ACCA Qualification papers in the Fundamentals Skills module or the Professional level (or conversion equivalent from the Professional Scheme for students registered with ACCA before 2008) – at my first attempt. YOUR DETAILS Student registration number First name/Western name Surname/family name Home address Town/city County/state Post/zip code Country Telephone number (including international dialling code Email address CHECKLIST You must ensure that the following documents are submitted with your application form: Completed Simpson Scholarship Submission Form. Essay: ‘How the award of a scholarship will help me to realise my full potential’. Contact details of two references. Failure to include the required documents will result in your application being rejected. DECLARATION I submit my application on the basis that I have met the criteria for application. I certify that the essay is all my own work and that I have not colluded with anyone, or reproduced any work which is not my own. If I am successful, I agree to my profile being used for publicity purposes. FOR OFFICE USE ONLY Application received (date) Registered student Completed Knowledge module Essay received No of words Reference 1 Reference 2