Open Society Foundations/Durham University Masters Scholarships in the field of Hazard, Risk and Resilience 2012-13

Application Form
Please refer to the Guidance Notes for Applicants, available at http://www.soros.org/initiatives/scholarship/focus_areas/uk/guidelines and University Webpage https://www.dur.ac.uk/international/postgraduate/fees/taughtscholarships/osf/masters, for more information on the scholarship offer, eligibility requirements, the application process, the selection procedure, information about Durham and relevant contact details.

APPLICATION FOR: MSc in Risk and Environmental Hazard*/MA in Risk and Security*/MA in Risk, Health and Public Policy* (*please delete as appropriate) 1. Personal details Family Name (as on passport) Title (Mr/Mrs/Ms/Miss) Date of Birth: Day Month Year Nationality (please include any second nationality/citizenship as well if applicable)

First name(s) (as on passport) Gender Country of Birth Country of normal residence

2. Contact details Address for Correspondence

Permanent Address (if different)

Telephone No: Fax No: E-mail address: Please ensure that your e-mail account is active or notify us of any changes.

Person to be contacted in your home country in case of emergency Name:

Address: Telephone Number: Relationship to you: 3. Proficiency in English Language Candidates whose first language is not English will normally be required to demonstrate proficiency in the English language by possessing a recent English language test score with overall band score of at least 6.5 in the IELTS test (with a writing score of 7.0 or above and no other element below 6.0) or at least 96 in the TOEFL IBT (Internet Based Test) (with individual components of Writing 27, Speaking 23, Listening 23, Reading 23 or above). In all cases the relevant certificate should have been issued within two years of the start date. Please note that short-listed applicants who are successful at the scholarship interviews and do not have valid English language test results will be invited for an English language test in their home country in April/May 2012. First language Other languages

Was English the language of instruction in your degree course? Which English language test have you taken (if any)? (e.g. IELTS, TOEFL, CBT, IBT) List test names and date taken.

What were your test scores? Listening Reading Writing Speaking Total

If you do not yet have your test results, when do you expect to have them?

Other evidence of English language proficiency:

4. Details of your Higher Education (give in date order, earliest first) Institution Dates attended Qualification Major Qualification From To obtained or Subject expected

Date of Award

5. Additional Qualifications In addition to the Bachelor Degree details entered above, please list here any other university or professional qualifications you have obtained (do not list qualifications obtained by less than 9 months of study):

6. Previous academic activities at Foreign Universities (if any): Please give details of any previous academic activities at Foreign Universities

7. Work Experience Please list any paid work you have done before, during or after university. Include full-time and parttime jobs. Give the names of employers, dates and main responsibilities.

8. Extra Curricular Activity Please give details of any extra curricular activities or voluntary work that are relevant to your application.

9.

Personal Statement Essay Question Please describe: y Why you want to study this course. y How the course will build upon your previous experience. y How the course will assist your future career, around hazard and risk, in your own country. Your answer should not exceed 1,000 words.

10. Referees Please give details of two referees who are able and willing to comment on your suitability for this. Do not choose referees who are related to you by family or marriage. Comments from your two referees should then be attached to this application form in closed envelopes. Your referees should state how they know you, how long they have known you for and why they think you are a suitable candidate for this scholarship. 1st Referee s Name: 2nd Referee s Name:

Job title:

Job title:

Professional Relationship to you (e.g. teacher, manager, etc.)

Professional Relationship to you (e.g. teacher, manager, etc.)

How long have you known this referee?

How long have you known this referee?

Email:

Email:

11. Medical If you have any condition that may require special facilities, please indicate the section below, and give any further information necessary on a separate sheet. This information will be treated confidentially and is solely intended to determine the level of provision you might require to support your studies. We do not usually regard disability or medical concerns as a reason for turning down any application, and aim to provide support to students with special needs. Do you have any medical conditions or disabilities that require special arrangements?

12. Criminal convictions The University has a legal responsibility for the safety of its students and staff. You are therefore required to state whether you have any unspent criminal convictions, excluding minor motoring offences. Please answer yes or no to indicate your situation. If you answer yes, you may be required to provide details of any convictions. Previous criminal convictions will not automatically affect your admission to the University.

(YES / NO / NO RESPONSE)
The University is committed to the safety and wellbeing of all students and staff. We must therefore know about any criminal convictions which are of a violent or sexual nature, or involve unlawfully supplying controlled drugs or substances. Convictions that are 'spent' (as defined by the Rehabilitation of Offenders Act 1974) are not considered relevant and should not be declared (please refer to the paragraph below for further details). If you are applying for certain s particularly related to teaching, health, social work and s involving work with children or vulnerable adults you must tell us about any criminal convictions, including 'spent' sentences and cautions (including verbal cautions) and bind-overs. If you are in doubt you should contact the International Office for further advice. An 'unspent' conviction is one that you must admit on disclosing your criminal history. A conviction for an offence for which a sentence of more than two and a half years was imposed will always remain 'unspent'. All applications will be considered on the basis of academic and/or professional merit, and the declaration of a previous criminal conviction will not automatically exclude you from the application process. However, the University may want to consider the application further or ask for more information before making a final decision. If any information on your application form changes after you submit your application, you should immediately inform the International Office. If you are found to have failed to disclose a relevant conviction the University reserves the right to cancel your application at any stage or, if you are already a registered student, require you to withdraw immediately.

Declaration I confirm that, to the best of my knowledge, the information given on this form is correct and complete. I give my consent for my personal data to be processed within the terms of the UK s Data Protection Act. Full name: Date

By submitting this form by 14 February 2012 to your local scholarship coordinator office (please, find contact details in the Guidance Notes for Applicants, Section 7) you will be deemed to have made the above declaration. Please refer to the guidance note for further information on the necessary paperwork for a complete application.