MEDICAL SCHOLARSHIP PROGRAMME

FOR POST-GRADUATE EMIRATI STUDENTS

APPLICATION FORM

PERSONAL INFORMATION
FULL NAME GENDER ! MALE ! FEMALE
DATE OF BIRTH PASSPORT NUMBER
MARITAL STATUS E-MAIL ADDRESS

ADDRESS
P O BOX HOME TELEPHONE
EMIRATE MOBILE

EMPLOYMENT INFORMATION (if applicable)
COMPANY
DESIGNATION
P O BOX
EMIRATE
WORK TELEPHONE

SCHOLARSHIP FOR INSTITUION AND PROGRAMME YOU ARE APPLYING FOR
*INSTITUTION PROGRAMME
ROGRAMME START DATE OFFICIAL ACCEPTANCE ! YES ! NO

*Kindly ensure that the programme you are applying for is accredited by the UAE Commission for Academic Accreditation
(www.caa.ae)


EDUCATION INFORMATION
List in chronological order all college/university records starting with the last institution attended:
NAME OF INSTITUTION SPECIALTY
ACADEMI
C YEAR
CITY/COUNTRY
DEGREE
ACHIEVED
GRADE / GPA





EMPLOYMENT HISTORY
List in chronological order starting with the last organisation attended:
NAME OF ORGANISATION DESIGNATION FROM TO




PERSONAL STATEMENT

The personal statement is an integral part of your application and will assist Al Jalila Foundation better understand you and
your motivations for pursuing postgraduate medical studies. As a guide your personal statement should cover the following
and be approximately 500 to 800 words in length:

! Reflect who you are and what you have achieved
! Provide examples of major accomplishments
! Highlight what makes you an outstanding candidate for this scholarship

REFERENCES
NAME ADDRESS | TELEPHONE | E-MAIL OCCUPATION

BRIEFLY INDICATE HOW YOU KNOW THIS PERSON




Please attach letters of recommendation to this application form (minimum two required).

I HEREBY CERTIFY THAT THE INFORMATION SUBMITTED IN THIS APPLICATION IS TRUE AND CORRECT.

NAME

SIGNATURE

DATE











APPLICATION CHECKLIST

Please submit the following documents and ensure that each document is clearly marked with your name to aid in
identification. All documents submitted are part of your application file and will not be returned to you.

" Completed Application Form
" Curriculum Vitae
" Passport Copy
" UAE nationality document (Khulasat AlQayd) if applicable
" Official acceptance from UAE institution
" Academic Transcripts
" GPA, TOEFL (or IELTS) scores
" Personal Statement
" Letter(s) of Recommendation

Applications and supporting documents to be mailed to:

Department of Programs
Al Jalila Foundation
P O Box 300100
Dubai
United Arab Emirates

Late and incomplete applications will not be considered by Al Jalila Foundation.

Scholarship Submission Deadline

The application deadline for the 2014/15 academic year is 15 August 2014. Shortlisted applicants will be informed of their
interview date in August 2014.