Preliminary selection will be based on the information submitted on this application form. Complete carefully and accurately, circling appropriate responses and use additional sheets if necessary for full details.
Please return your form by email to scholarships@theiet.org
or by posting to: WES Doris Gray Scholarship,
Scholarships & Prizes, The Institution of Engineering and Technology, Michael Faraday House, Six Hills Way,
Stevenage, Hertfordshire. SG1 2AY
The closing date for applications is Friday 30 th June 2006 . Long-listed candidates will be contacted by Monday
31 st July. If you have not heard by then, you should assume that you have not been selected for further assessment.
1.
Surname:
2.
Home Address:
First name(s): Date of Birth:
3.
Tel. No. Mobile No. Email
4.
Please indicate by circling your nationality/citizenship/residence category (please be precise!)
UK National EU National UK Refugee status
UK Asylum Seeker UK Permanent Resident status Other (give details)
5.
Will you have lived (for other than educational purposes) in the UK for at least 3 years at 01 Sep 06?
YES/NO
6.
Do you intend to remain and work in the UK following your course? YES/NO
1.
Place of study in academic year 2005/2006:
2.
Exams with subjects already taken, up to and including this academic year, with results (inc. GCSEs etc.):
3.
Exams still to be taken in 2005/2006 or results to be received (e.g. A-levels, Highers, Access course, etc.):
4.
If accepted onto a course as an exceptional or mature entry, please give brief details of your acceptance:
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1.
First choice institution and course (e.g. MSc., M.Eng., B.Eng., B.Sc. or HND and specific title):
2.
Reasons for choice of institution and course:
1. Are you an independent student as defined by the Department for Education and Skills (DfES)? YES/NO
2. If YES to D1 above, please give details.
3. Have you or your parents/spouse completed and submitted the forms for student support from the Student
Awards Agency for Scotland (SAAS): maintenance?
5. If you answered YES to D5, please give details as notified by the LEA/SAAS:
YES/NO
4.Have you/your parents/spouse been notified by the SAAS of the expected level of contributions to fees and
YES/NO
6.
In all cases , please give your own estimate of your family's annual residual income based on the gross income minus the deductions allowed by the LEA. (This information is kept confidential but is necessary to help us estimate the expected level of your family's contribution; please consult DfES information for guidance and definition of annual residual income .)
7. If not an independent student, are your parents willing and able to pay the estimated contribution to
YES/NO fees/maintenance?
8. If you answered NO to D8 above, please give reasons.
9. Have you obtained or are you applying for any other grant, bursary, sponsorship or award? YES/NO
10. If YES to D9please give details, including wherever possible estimates of the expected funds.
11. Are there any particular circumstances that lead to additional costs and financial hardship?
12. If YES to D11, please give details, including wherever possible estimates of the costs incurred.
YES/NO
The Women’s Engineering Society (WES) aims to enable more women to qualify as engineers and to increase the representation of women in the profession, and we work hard to obtain the sponsorship that supports these bursaries.
While financial hardship is the main criterion for selection for a bursary, we are also interested in your potential as
Note: info on finance for students in England and Wales can be found in the Department for Education and Skills (DFES) financial support guides on www.dfes.gov.uk/studentsupport/ . For Scottish students, refer to the Students Award Agency for Scotland (SAAS) on www.student-supportsaas.gov.uk
. Northern Ireland students should refer to their Education and Library Board or see www.student-support.org.uk
for further info
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an engineer, in employment and in the community. Please tell us more about yourself, including some or all of the following:
 what or who has inspired you to study engineering?
 your career plans in the profession
 your views on the responsibilities of engineers in society
 are there any special circumstances which mean you would particularly benefit from the support offered by a
WES Doris Gray Scholarship?
 in what ways would you (as a student or as a professional engineer) be willing to help WES achieve its aims?
1. Please provide the name, address, telephone number and relationship to you of a referee (e.g. teacher), contactable in the summer, who can provide information on your academic performance and preferably also on your personal circumstances:
2. From whom/where did you obtain the information about the WES Doris Gray Scholarship?
Signature: .............................................................. Date: ......................................
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