Application Fee Waiver Request Form

Individuals who consider themselves to be facing financial hardship may submit this
completed form, with supporting documentary evidence in order to be considered for
a waiver to Imperial’s postgraduate application fee.

Please complete all fields and return the form with your supporting documents via
email to appfees@imperial.ac.uk with ‘Application Fee Waiver Request’ in the
subject line. Your request will then be considered and a decision will be sent to you
directly via email. The decision of the College will be final and cannot be appealed.
An application may be rejected on the basis of insufficient documentation to
evidence the circumstances outlined. Repeat applications cannot be made within the
same admissions cycle.

Section 1 – Applicant Details

First Name: Christian

Last/Family Name: Mutombo Matanda
Date of Birth (DD/MM/YY): 12/08/1984
Permanent Address: 7079 Avenue Kasai
Email Address: cmutombo@ibec-solutions.com
Nationality: DR Congolese
Country of Residence: Democratic Republic of Congo
Have you lived in your current country of residence since birth: Yes.
Imperial Course(s) you intend to apply for: Innovation, Entrepreneurship and
Management

Please select one of the following two options that you feel best reflects your
circumstances or hardship: Short-term/temporary hardship.

Section 2 – Supporting Statement

*Please use this section to provide a supporting statement outlining your

circumstances of hardship and reasons for requiring a waiver to the application fee.
Please note that your submission should include supporting documents that
evidence your statement.

My name Respected Sir,

I hope all is well with you. I am writing this email in the hope of getting my application fee
waived for my application at the Imperial College Business School.

My name is Christian Mutombo and I have completed my Bachelor's degree in Business

Administration from the University of Lubmbashi in the Democratic Republic of Congo
(DRC) and would like to enrol for my further education in Innovation, Entrepreneurship and
Management in your institution. I plan to study this course for the main reason
Section 3 – Declarations and Consent

I confirm that the information that I have provided is true and understand that this
information will be checked against any formal application I submit for a course of
study. I understand that the College reserves the right to withdraw any application,
offer made or period of enrolment where it is identified that false or misleading
information has been provided in the application for a fee waiver.

I consent to the information that I have provided being processed for the purpose
of consideration for an application fee waiver and that my data will be processed in
accordance with Imperial’s Privacy Notice:
https://www.imperial.ac.uk/media/imperial-college/administration-and-support-
services/registry/academic-governance/public/academic-policy/admissions/Privacy-
Notice-for-Students-and-Prospective-Students.pdf