PROSPECT BURMA
SCHOLARSHIP APPLICATION FORM
2015
FOR NEW APPLICANTS APPLYING TO STUDY OUTSIDE OF THAILAND, THE PHILIPPINES
AND HONG KONG
This form is only for new applicants. If you received a Prospect Burma scholarship for the 201415 academic year and are continuing in the same degree programme, you should complete the
shorter form headed Application for Continued Funding.
All forms are available on the Scholarship Applications page at www.prospectburma.org
Deadline for submission: 3 April 2015
The following documents must be submitted to the appropriate address listed on the
following page:







A completed copy of this Application form;
Proof of enrolment at a university or college
Copy of any letter giving other awards or grants
Copy of recent academic records and any existing academic references you may have
Copy of the personal details page of your passport or travel document
Any additional information you feel supports your application
If planning to study in South East Asia or Hong Kong please use the appropriate form
Applications mailed after 3 April will not be accepted
2015 PROSPECT BURMA SCHOLARSHIP APPLICATION FORM
Page 1
Submitting your Application
Submit all documents by 3 April 2015 to:
Applicants wishing to study in all countries apart from South East Asia and Hong Kong should
send hard copies (Email is not acceptable) of their applications and supporting documents to:
Scholarships Committee
Prospect Burma
Porters’ Lodge,
Rivermead Court,
Ranelagh Gardens,
London SW6 3SF
United Kingdom
Please note that we will not be accepting NEW applications from students wishing to study
in India, except for those associated with Health and Hope Society. Health and Hope applicants
will need to submit their forms directly to Prospect Burma at the address listed above.
2015 PROSPECT BURMA SCHOLARSHIP APPLICATION FORM
Page 2
Name:
University:
Your Email: (print clearly and tell us
immediately if you change your email):
PROSPECT BURMA
Scholarship Application form 2015 for New Applicants



Answer ALL questions fully in English in black ink
APPLICATIONS MUST BE SUBMITTED TO THE ADDRESS SHOWN IN THE GUIDANCE NOTES BY 3 April 2015
We do NOT acknowledge receipt of applications. If you have not heard from us by 31 July, you should assume that
your application was unsuccessful
SUMMARY OF YOUR APPLICATION
Name:
Date of Birth:
Male/Female:
Ethnic origin
Level of Degree studying for(eg BA, MA etc)
Subject:
Course begins/ends (month/year):
Funding requested (state amount & currency):
FOR OFFICE USE ONLY. DO NOT WRITE ANYTHING BELOW
Registered:
New Student:
Yes/No
Previous study report received:
Course enrolment confirmed:
Offer of Place:
References: Sent for
Received
Scholarship C’tee decision:
Final decision:
Reject
Checked
Applicant short-listed :
□
Accept
□
Yes/No
Amount granted:
Successful applicant notified:
Grant letter issued:
Funds transferred on:
Returned signed:
Receipt acknowledged:
Notes:
2015 PROSPECT BURMA SCHOLARSHIP APPLICATION FORM
Page 3
Name:
1. YOUR PERSONAL DETAILS
Full Name:
Date of Birth
Aliases (if any):
Place of Birth
Male/Female
Ethnic origin:
Married/Single
No. of Children
Mailing Address:
City:
Post Code:
Country:
Where are you making this application from: (province/state, country)
Telephone:
(country code & number)
Fax:
E-Mail:
Details of passport or other travel document:
Number:
Issuing Authority:
Place & Date of issue:
2.
FAMILY INFORMATION
If either or both parents are retired or deceased, please give their previous occupation
Father:
Name
Country of residence:
Occupation:
Mother:
Name
Country of residence:
Occupation:
Are you the first member of your family to attend
YES/NO
university?
If no please give details of your parents education below: (course and level (eg.
undergraduate/postgraduate/doctoral))
3. STUDENT STATUS:
Delete one of the following:
Name of university /college:
a) I have applied to:
b) I have been accepted for :
Address of your university/college:
2015 PROSPECT BURMA SCHOLARSHIP APPLICATION FORM
Page 4
Post Code:
Country:
Telephone:
Email:
Name:
Are you currently enrolled in a first degree (undergraduate) course?
YES/NO
If YES, attach documentation confirming that you are registered as a student.
Are you currently enrolled on a postgraduate degree course?
YES/NO
If YES, attach documentation confirming that you are registered as a student.
Do you have a confirmed offer of a place on a postgraduate degree
course?
YES/NO
If YES, attach a copy of the offer.
If you cannot attach all the required documents when submitting your application, please
explain the reasons in a covering letter; and send the documents as soon as they are
available.
Applications without all necessary supporting documents will be rejected.
You may attach further documents if you think they will help your application.
4. DETAILS OF YOUR COURSE:
Title:
Is the course?
FULL TIME
PART TIME
(Please delete as appropriate)
Starting Date: (Month/Year)
Expected finishing/graduating date:
(Month/Year)
Beginning of the academic year for which you
will be funded: (Month/Year)
End of the academic year for which you will
be funded: (Month/Year)
Year of study for which you will be funded (e.g. 1st of 4 years):
What is your main subject of study?
What is the title of your thesis? (If appropriate)
What qualification do you hope to receive from this course, eg BA, BSc, MA, MSc?
2015 PROSPECT BURMA SCHOLARSHIP APPLICATION FORM
Page 5
Name:
5. PREVIOUS EDUCATION
a. Name & location of Secondary School attended:
b. Subjects studied:
Examinations passed with dates:
c. Details of College/University attended:
Examinations passed with dates:
d. Details of any formal English language tuition/examinations (eg TOEFL or IELTS) passed,
with score:
6. REFERENCES
Names and addresses of people who can comment on your academic ability (one of these must be your current or
most recent academic supervisor):
First Referee
Second Referee
Name:
Name:
Address:
Address:
Telephone:
Telephone:
Fax:
Fax:
Email:
Email:
Attach at least one written academic reference.
If you fail to give the names of ACADEMIC referees, it will delay consideration of your application.
Names of friends, other students, or relations ARE NOT ACCEPTABLE.
2015 PROSPECT BURMA SCHOLARSHIP APPLICATION FORM
Page 6
Name:
7. FINANCIAL INFORMATION
All applicants must disclose all other financial support. Failure to comply or false statements will result in immediate
disqualification. If the exact figures are not known, please estimate how much you will receive.
Eligible candidates may request assistance for tuition, living expenses, books or other academic materials, and
transportation to and from the school for the duration of academic year 2015/2016. Costs which were incurred before
or will be incurred after this period may not be requested in this scholarship form.
A) WHAT ARE YOUR COSTS?
In this section please show all of the costs related to your study for the academic year 2015/2016, even if you have
already covered some of these costs.
Please specify the Currency used for all costs ____________________________
1. Academic Fees:
This includes all the fees that you are required to pay to your school or university. If you have a fee waiver,
show the full costs before the waiver is deducted.
2. Housing Costs:
This includes rent, electricity and water charges. If you share accommodation, show only your contribution
towards the total rent.
3. Living Expenses:
This includes food, drink, clothing, toiletries, laundry and health insurance costs. If you share these costs,
show only your contribution to the total.
4. Other expenses
a) Books, stationery and essential equipment:
b) Uniform:
c) Passport and visa costs:
d) Daily travel to college/university:
e) Travel for research/academic assignments:
f)
Other (Please Specify):
Sub Total (Items 4a-4f)
5. TOTAL COSTS (Items 1-4):
2015 PROSPECT BURMA SCHOLARSHIP APPLICATION FORM
Page 7
Name:
B) WHAT ASSISTANCE DO YOU ALREADY RECEIVE?
In this section please show all of the financial assistance, assistance in kind (eg free accommodation or food), fee
waivers, loans, grants, or discounts you expect to have for the academic year 2015/2016 to help you cover the total
costs you have shown in Number 5 above.
If you are not yet sure of the financial support that will be available to you please attach a covering letter to explain
who you have applied to for funding, how much you have applied for and when you expect to hear the result.
6. Amount of Scholarship or Sponsorship:
If you do not have a scholarship or sponsorship, leave this blank.
7. Amount of Fee Waiver:
If you do not have a fee waiver, leave this blank.
8. Loans & Grants, including state benefits:
If you do not have loans or grants, leave this blank.
9. Income from Part-Time Work:
If you do not have income from part-time work, leave this blank.
10. Personal Savings:
If you do not have personal savings, leave this blank.
11. Family Contribution:
If you do not have a family contribution, leave this blank.
12. TOTAL PROVIDED BY OTHER SOURCES (Items 6-11)*:
*This section cannot be left blank. You must show that you have some other funds by providing information for
some or all of selections 6-11.
FINAL CALCULATION FOR SCHOLARSHIP REQUEST
This section shows the amount of money you are requesting from Prospect Burma for the academic year
2015/2016. This is calculated by subtracting the funds that you already have (shown in No. 12) from the total cost
for this period (shown in No. 5).
TOTAL AMOUNT REQUESTED:
The amount on line 12 subtracted from the amount on line 5.
2015 PROSPECT BURMA SCHOLARSHIP APPLICATION FORM
Page 8
Name:
C) DETAILS OF YOUR BANK ACCOUNT:
Name of Bank and full branch address:
SWIFT code:*
Name in which account is held:
Bank clearing code (if any)*:
Account number:
We prefer that you have your own account, but if you use a friend’s account, be sure they agree.
*Ask your bank for the codes needed for international bank transfers
Prospect Burma only offers partial awards; how will you cover the rest of your expenses?
8. BIOGRAPHY:
In an essay of approximately 500 words in length give details about your upbringing with particular reference to
Burma's social and political situation. If you are no longer living in Burma we would be interested in why you moved
away. We are particularly interested in volunteering and community work you may have undertaken. (Please
complete this section in handwriting)
2015 PROSPECT BURMA SCHOLARSHIP APPLICATION FORM
Page 9
Name:
9. FUTURE PLANS:
This section is very important. The essay must be your own. Candidates submitting identical essays will be
disqualified.
With reference to your chosen subject, please tell us about your future plans and how you will benefit Burma after
graduation. Your essay should be approximately 500 words. Continue on a separate sheet of paper if necessary
and sign it. (Please complete this section in handwriting)
Signature…………………………………………………………….Date……………………………
If you are awarded a scholarship, we will ask you to sign an undertaking that you will to return to Burma when
feasible to help your country’s development.
2015 PROSPECT BURMA SCHOLARSHIP APPLICATION FORM
Page 10