UNIVERSITY SCHOLARSHIPS

:
2017
SCHOLARSHIP

Application Form for Admission to a
Research Degree Programme

Surname                
1
APPLICANT’S Other names                
DETAILS
Permanent Home Address * Address for Correspondence (if different)
                     
                     
                     
                Post Code:      
Post Code:      

Telephone:                 Telephone:      

Email:                     

Faculty: Choose an item.
2
PROPOSED Qualification Aim:
PROGRAMME MPhil/PhD
OF STUDY
Mode of Study: Full Time Part Time
Proposed Start Date: Month       Year      

University Scholarship Reference: Choose an item.

If you have had contact with a member of academic staff and they have expressed interest in
supervising your proposed research programme please state their name:
               

Who is expected to pay fees? Applicant Research Council Employer
3 Sponsor/Parent/Guardian Other (please specify)
FEES/
SPONSORSHIP Name and address to which fee invoice is to be sent (if other than applicant)
     
     
     

If your attendance at the University will be conditional upon the agreement
of your employer, please tick

Educational or Other Referees (please send report forms available on the internet to referees)
4
REFERENCES First Referee Name                 Second Referee Name                

(At least one must
be an academic Position                 Position                
reference)
Address Address
                               
                               
                               
           

* Unless other instructions are given correspondence will be sent to the permanent home address

SCHOLARSHIP Institutions Attended From To Examinations Taken and Grade Date 5 Qualifications Obtained EDUCATION Education since                                               leaving school                                                                                             (Please submit copies of all                                               relevant certificates with your Examinations to be taken/with Grade Date application) results pending (give subject and qualification)                                                                       Present Position       Date of       6 Appointment EMPLOYMENT EXPERIENCE Workplace Address                   Telephone       Name and Address of Employing Body (if different from above)                   Telephone       Details of previous posts held From To                                                                                                                               What is your first language?       7 ENGLISH If your first language is not English please state your IELTS score       or TOEFL score:       LANGUAGE If you have not taken an English test yet. what date do you plan to take it?       PROFICIENCY What other English Language qualifications do you hold?       How many years have you studied English Language?       Have you been taught in English in your home country? YES NO If you please give details below:       .

Indicate your main areas of interest. If enrolled. the University may ask you for further details. If you tick the ‘Yes’ box. SCHOLARSHIP Give a statement of your reasons for wishing to undertake this programme and any other details you 8 feel may be relevant to your application.ac. 9 MARKET Prospectus TV Advert Careers Office Careers Fair Radio Advert RESEARCH Own Initiative Press Advert Other (please specify)       You must declare if you have a relevant criminal conviction. to the best of my knowledge. CRIMINAL Yes CONVICTIONS Please note that if you are convicted of a criminal offence while your application is being processed. the information I have given Date 11 above is correct in every detail. You may use the space SUPPORTING below or attach a statement.uk .       Please specify how you came to hear of our research opportunities. STATEMENT Please do not exceed 500 words. I declare that. you should notify the University immediately. Confirmation of Declaration The completed application form should be returned electronically to researchstudents@dmu. Please tick one box. I agree to abide by the regulations DECLARATION in force at the time. including violence against the 10 person or drug dealing.