EMERALD STUDENTSHIP
APPLICATION FORM 2014-15
Please tick the following before completing the application form:
I have applied for admission from King’s College London for 2014-15 MSc Global Mental
Health
I enclose proof of English Language scores
Please note that your application will not be processed further if you have not fulfilled the
above.
Family Name or Surname
First Name/s
Address(es) for the past 2 years
Contact Telephone No.
Contact Email Address
Nationality
English Language (IELTS) Scores
Highest Educational Degree (Year,
University/College and Score/Mark)
Other Qualifications (Year and Institutional
Affiliation)
Professional Qualifications (if any)
Name, Address and Email Address of Current
Employer (if relevant)
Name and Email Address of 1st Referee
Name and Email Address of 2nd Referee
List relevant work/volunteer experiences within the public health field
(list up to three relevant positions; include addresses, dates, descriptions of responsibilities,
and name of contact person; this can include your current position)
Describe your ideas/proposal for your MSc dissertation, and how this will contribute to the
EMERALD project, along with a potential supervisor from within the EMERALD project (in
approx. 300 words; this should have been agreed with the potential supervisor prior to
application)
Describe how, upon completion of the MSc in Global Mental Health, you intend to use your
newly acquired training and skills to help improve mental health services and systems in
your country (in approx 300 words)
If I am successful in gaining the studentship
 I give consent for KCL and its studentship partners to announce my name and the
award, and to use photographic images of me, in their publications and websites.
 I consent to my application forms, transcripts and references being released to the
studentship subpanel.
Signature ____________________________________________Date ___________________
If you have any questions about the studentship, please contact Dr Maya Semrau
(maya.semrau@kcl.ac.uk) or Prof Graham Thornicroft (graham.thornicroft@kcl.ac.uk) at KCL.
Please return the application by email to maya.semrau@kcl.ac.uk by 30th April 2014.