BG Tanzania Postgraduate Scholarship Scheme for Geoscience and
Engineering
Application form
Please send by post officer the completed application form to:
BG Tanzania Scholarship Scheme Application,
BG Tanzania Scholarship Project,
British Council,
Samora Avenue/ Ohio Street,
P.O.Box 9100,
Dar es Salaam - Tanzania
Please complete all parts of this form in black ink or typescript and
attach a recent photograph of yourself.
PHOTOGRAPH
Also complete the enclosed Medical Clearence Form and send together
with this appliocation form
A note at the end of this form explains who will see the information
you supply to us, and why.
Please attach your latest CV, academic certificate, academic transcript and two letters
of reference, preferably academic ones and medical forms. Without these documents your application
will not be considered.
Part A Personal details
Family name
(as it appears in your
passport)
Other name(s)
Title
Mr
Mrs
Sex
Male
Female
Place of birth
Status
Miss
Ms
Dr
Date of birth
Single
Married
Divorced
Widowed
Nationality
Number of children (if
applicable)
BG Tanzania Scholarship Scheme for Geoscience and Engineering 2015
Your address where we should send letters
Name, address of next of kin or person in your home country
who should be contacted in the event of an emergency
(please state relationship).
E-mail
E-mail
Telephone number
Telephone number
Mobile number
Mobile number
Please tick this box to confirm that you have told your emergency contact that you have given us their details.
Where are you currently working or studying?
If you are currently working, please provide details of your post, grade and main responsibilities.
Contact details of line manager
Name of your line manager
Position
Department
Organisation
Address
Telephone number
Fax
E-mail
If you are currently studying, what qualification do you expect to obtain, and when do you expect to obtain it?
2
BG Tanzania National Scholarship Scheme for Geoscience and Engineering
2015
Part B Academic background
Please list all academic qualifications gained from secondary education, stating the institutions attended, the main subjects of
study, and when the main courses started and finished. Please indicate with an asterisk (*) those courses that were entirely, or
mostly, in English – i.e. where the language of instruction or supervision was English. Please attach photocopies of all relevant
academic certificates and transcripts, with accompanying translations into English if they are in another language.
Qualification
(including class or level)
Institution
Subject
From
To
From
To
Part C Professional background
Please list all positions held since completing your secondary or tertiary education.
Position
Organisation/institution
3
BG Tanzania National Scholarship Scheme for Geoscience and Engineering
2015
Part D Proposed course of study to the University/ Institute in Tanzania
What qualification would you like to obtain, and in which subject(s)?
It should be from Ardhi University, Dar Es Salaam Institute of Technology, University of Dar Es Salaam or University of Dodoma
only.
1
At which institution would you like to study?
It should be from Ardhi University, Dar Es Salaam Institute of Technology, University of Dar Es Salaam or University of Dodoma
only. Please attach photocopy of an offer/ admission letter
1
Are you applying for any other scholarships or awards to study in the local
universities?
Yes
No
If ‘yes’, please give full details.
How did you find out about the BG National Scholarship Scheme?
My employer
A colleague or friend
Promotional material
Internet search
Newspaper
Other – please specify
Part E Referees
Please attach letters from two (2) referees (one should be professional from your recent employer and one should be academic) in
support of your application for a BG National Scholarship. Please provide details of the two referees below. If you are unable to
attach letters from your referees, please ask them to write to us as soon as possible.
First referee
Title and name
Position
Telephone number
Fax
E-mail
How long have you known this referee?
What is his/her professional relationship to you?
Second referee
Title and name
Position
Telephone number
Fax
E-mail
How long have you known this referee?
What is his/her professional relationship to you?
Please tick this box to confirm that you have informed your referees that you have given us their contact details.
4
BG Tanzania National Scholarship Scheme for Geoscience and Engineering
2015
Part F Statements about yourself and your plans
Personal statement
What are your reasons for applying for the course you wish to study? Explain how it will help your career and personal development
to Tanzania. Try to do this in no more than 500 words. Be brief – we can explore in detail at the interview if necessary.
Your plans for the future
Please provide an outline of your ambitions and career plan. How do you intend to ‘make a difference’ in Tanzania? Try to do this in
no more than 250 words. We can discuss your plans at the interview.
5
BG Tanzania National Scholarship Scheme for Geoscience and Engineering
2015
Are you a potential leader?
The BG National Scholarship Scheme looks for future leaders, who can use their influence and standing to bring benefits to their
communities and countries. Describe your most outstanding non-academic achievement where you demonstrated leadership
potential. It should involve other people, and it may be an extra-curricular/sport/community/professional activity or an assignment.
Try to do this in no more than 250 words. We can discuss it further at the interview.
6
BG Tanzania National Scholarship Scheme for Geoscience and Engineering
2015
Important information that you should read and understand before signing this application form
The British Council will provide the following services in support of the BG National Scholarship Scheme:
1. Certficates/ documents – attach mentioned/ important certificates/ transcripts only.
2. Selection of candidates – full recruitment and selection of candidates, including general advice on entry requirements for study
on postgraduate courses in Tanzania
3. English Language Proficiency – All applicants should demonstrate IELTS level 5.5 to be considered for shortlisting together
with other requirements.
4. Pre-enrollment briefings – British Council will provide pre-enrollment briefing to scholars before they report to the participating
local universities/ institutes.
5. Payment of scholar fees and allowances – British Council will arrange the payment of scholar allowances. The range of
scholar allowances is subject to prior approval but may include: tuition fees; monthly stipend/ allowances; thesis allowance;
book allowances and other allowances as approved by BG Tanzania National Scholarship Scheme.
6. Welfare and disability support – local universities will be the only point of contact for scholars with any welfare issues.
Data Protection
Thank you for providing us with information about yourself on this form. We will look after the information carefully and use it to
consider your suitability for a Scholarship and to manage the application process. It will be made available to staff at the British
Council and BG Tanzania. It may also be made available to members of any panel that interviews you. Your information may also
be passed to participating higher education institutions in Tanzania to help secure a place on a course of your choice. After we
know that you have a confirmed place on a course we will ask you again for permission to use the information in new ways that will
become necessary as you proceed to take up your Scholarship. If you are unsuccessful the information will be held securely and
destroyed in due course
In signing this application form for a BG Tanzania National Schoalship for Geoscience and Engineering you accept that you will be
bound by these conditions.
You also accept that we will use the information you have given us in the ways we have described.
Signature
Date
FOR OFFICIAL USE ONLY
TO BE COMPLETED BY BRITISH COUNCIL
Other documents attached to this form (please tick):

Photograph

Photocopies of academic certificates (and translations, if relevant)

CV

Letters from two referees

English Language Test Certificate

Medical Form
7
BG Tanzania National Scholarship Scheme for Geoscience and Engineering
2015
Medical report form
British Council, P.O.Box 9100,Dar es Salaam.
Part 1 Candidate’s declaration
Failure to disclose important information may cause the award to be refused or cancelled.
First name
Last name
Date of birth
Address
Recent photograph to be
affixed here before
examination
Telephone
E-mail
Do you have any medical condition or disability?
Yes
No
Do you take any regular medication?
Yes
No
Have you ever had a serious accident?
Yes
No
Yes
No
Yes
No
Yes
No
If you have answered ‘yes’ to any of the above
questions, please give brief details.
Are you likely to need any special provisions or
treatment during the period of your award?
If yes, please give brief details.
During the last five years have you been referred to a
hospital or undergone X-ray or other investigations?
If yes, please give brief details.
Have you ever had a nervous breakdown or needed
psychiatric advice?
If yes, please give brief details.
Please sign below, only in the presence of the examining doctor.
Name
Signature
Date
Note: a chest X-ray report (not the actual X-ray) must be attached to this form. If there is any significant change in your
condition in the interval between completing this form and statring of your award year in your own interest you must
inform the British Council immediately.
8
BG Tanzania National Scholarship Scheme for Geoscience and Engineering
2015
Part 2 Examining doctor’s report
We need to know whether the candidate is physically and mentally fit to undertake a course of study. While you will wish to tell the
applicant about any finding requiring further investigation or treatment, your overall opinion is confidential to the British Council and
should not be discussed with the candidate. Please seal the form to be delivered to British Council with confidentiality.
General health and physique
Height (cm)
Weight (kg)
Urinalysis – sugar
Urinalysis – albumin
Blood pressure (mm Hg)
Sight and hearing
Chest X-ray
Please record any abnormal findings on general physical examination and any doubts you may have about the candidate’s
mental stability.
Please comment on any statements in Part 1 of this form stating how you believe it may affect the course of study.
Will the candidate require any special treatment or medical
attention while studying? Please give brief details.
Yes
No
Do you consider the candidate fit to undertake the
proposed course?
Yes
No
Name
Address
Signature
Date
For completion by the overseas British Council office
(or Mission where there is not a British Council office).
The medical examination report should be referred to British Council Manchester for advice on any abnormal findings.
Name
Signature
Date
9
BG Tanzania National Scholarship Scheme for Geoscience and Engineering
2015
Declaration of health
British Council, P.O.Box 9100,Dar es Salaam.
Your full name
Date of birth
Country
I am pregnant.
Yes
No
In the past 12 months I have received medical treatment.
Yes
No
Yes
No
If you have
answered ‘yes’ to
either question,
please give brief
details.
I declare that I am in good health and fit to take up an award.
Please give brief
details and tell us
if you are
receiving medical
treatment at
present.
Data Protection Notice
British Council will use the information you have given on this form and any statement that is provided by a medical professional to
assess that you are fit to study. By signing and returning this form you consent to this process.
Signed
Date
10
BG Tanzania National Scholarship Scheme for Geoscience and Engineering
2015