Application for Support by students from Pakistan already registered or accepted for a Ph.D.

or equivalent course in a British University or recognised institution of higher education in

the UK.

1. Name: ………………………………………………………………………………………

2. M/F: ………………………………………………

3. Date of Birth: ………………………………………………………………………………………

4. Address in Pakistan:
………………………………………………………………………………………

………………………………………………………………………………………

5. Address in the UK (if applicable)

………………………………………………………………………………………
………………………………………………………………………………………
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6. Tel no…………………………………………………………………………

7. Email address ………………………………………………………………….

8. Details of educational qualifications

………………………………………………………………………………………
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9. UK Education Institution at which the applicant is registered for a post-graduate level course of
study (please send a copy of the registration document)

………………………………………………………………………………………
………………………………………………………………………………………
………………………………………………………………………………………

10. Course registered for

………………………………………………………………………………………

11. Topic of research (This is a key selection criterion. Please include as much detail as necessary
or submit a summary on a separate sheet.)
………………………………………………………………………………………
………………………………………………………………………………………
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12. Current status of project / Expected date of completion

………………………………………………………………………………………

13. Reference/Letter of Support: insert here the name, position, and contact address of your
academic supervisor or principal contact within your UK educational institution. You should invite
this person to submit a Letter of Support for your application to the trust’s e-mail address,
preferably as a Word attachment on headed paper. The letter should comment briefly on three
aspects of your application: firstly, your academic progress and commitment; secondly, your
personality (why the candidate is worth supporting); thirdly, your financial circumstances (why the
candidate needs supporting)

………………………………………………………………………………………
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14. Purpose for which financial support is required
………………………………………………………………………………………
………………………………………………………………………………………

15. Estimated sum required (Maximum £1,000) £ .................

16. Details of scholarships received or applied for, and of other sources of financial support.
[Applicants will need to satisfy the Trustees that they will have access to sufficient funds from
other sources to enable them to complete their course.]

………………………………………………………………………………………
………………………………………………………………………………………
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17. Proposed career on return to Pakistan

………………………………………………………………………..................…
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………………………………………………………………………………………
………………………………………………………………………………………

Signed………………………………………………………….

Date ……………………………

Please send this completed form (preferably by e-mail) with additional material if desired to:

Tim Butchard, Secretary, The Charles Wallace Pakistan Trust

4, Dorville Crescent, London W6 0HJ, The United Kingdom

E-mail: timbutchard@wallace-trusts.org.uk

March 2009

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