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Application Form

The Chancellor’s Scholarship


Application Form
Closing Date: 30th June 2010
The Chancellor’s Scholarship
Application Form
Scholarship Closing Date: 30th June 2010

Personal Details
Family Name:       First Name:      

Previous Name:       Gender: Male Female

Title (Mr, Mrs,


Date of Birth:            
etc):
Address:
     

     

Postcode:
      Country:      

Tel No:
      Mobile:      

Email:
     

Information About Your Programme


New Students Only Existing Students Only
UCAS Number:
      Student Number:      

Student Number:
      Current year of study      

Year of Entry:       Title of Programme:      

Title of Programme      

Type of Scholarship:
Academic: Sporting Achievement: Community/Cultural Activity:

Referees: (Written referees MUST be on letter headed paper and attached to application)
1 Name:       2 Name:      

Address:       Address:      

           

           

Work Work
           
Email: Email:
Record of Achievement

Academic History

List all educational institutions attended after the age of 16, starting with the most recent

Institute name and address Dates attended Qualifications gained/pending

                 

Practical English language experience (e.g. period of


For overseas applicants residence in English speaking country; tuition in English
English Language Qualification medium school or university)

IELTS TOEFL Cambridge      

(state score and attach copy of certificate)

Details of any further examination to be taken before commencing degree programme and date of result

     

Work Experience (if applicable)

     
Sporting Achievements

     

Community/Cultural Activity

     

Funding (for International students only)

Self
Support
Parents Scholarship Other

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