PROSPECT BURMA

SCHOLARSHIP APPLICATION FORM

2011

FOR NEW APPLICANTS

This form is only for new applicants . If you received a Prospect Burma scholarship for the 2010-2011 academic year and are continuing in the same degree programme, you should complete the shorter form headed Application for Continued Funding.

All forms are available on the Scholarship Applications page at www.prospectburma.org

Deadline for submission: 31 March 2011

The following documents must be submitted to the appropriate address listed on the following page:

A completed copy of this Application form; Proof of enrolment at a university or college Copy of any letter giving other awards or grants Copy of recent academic records and any existing academic

references you may have Copy of the personal details page of your passport or travel

document Any additional information you feel supports your application

For applicants in India only : Paste a passport-size colour photo in the box shown on the form

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Applications mailed after 31 March will not be accepted

Submitting your Application

Submit all documents by 31 March 2011 to:

INDIA

Applicants wishing to study in India should send hard copies (Email is not acceptable ) of their applications and supporting documents to:

Ms Lata PillaiStudent Information CentreA-Block, Pocket-AG1141C, VikaspuriNew Delhi-110018IndiaTel: +91 981 095 9926E-mail: cholwin2000@yahoo.co.in

SOUTH EAST ASIA AND HONG KONG

Applicants wishing to study in Thailand, Cambodia, Laos, Vietnam, Malaysia, Singapore, Indonesia, the Philippines, and Hong Kong should mail or Email their applications and supporting documents to:

Ms Julie AbbotRegional Scholarship Co-ordinatorP. O. Box 8Mae Ping Post OfficeChiang Mai 50301ThailandTel +66 53 277 603E-mail: juliepbsea@gmail.com

ALL OTHER COUNTRIES

Applicants wishing to study in all other countries should send hard copies (Email is not acceptable ) of their applications and supporting documents to:

Scholarships CommitteeProspect Burma

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Porters’ Lodge,Rivermead Court,Ranelagh Gardens,London SW6 3SFUnited Kingdom

PROSPECT BURMA

Scholarship Application form 2011 for New Applicants

Answer ALL questions fully in English in black ink APPLICATIONS MUST BE SUBMITTED TO THE ADDRESS SHOWN IN THE

GUIDANCE NOTES BY 31 MARCH 2011

We do NOT acknowledge receipt of applications. If you have not heard from us by 31 July, you should assume that your application was unsuccessful

SUMMARY OF YOUR APPLICATION

Name: Date of Birth:

Male/Female: Ethnic origin

Level of Degree studying for(eg BA, MA etc)

Subject:

Course ends (month/year): Funding requested (state amount & currency):

FOR OFFICE USE ONLY. DO NOT WRITE ANYTHING BELOWRegistered: New Student: Yes/No

Previous study report received:

Course enrolment confirmed: Offer of Place:

References: Sent for Received CheckedScholarship C’tee decision: Applicant short-listed : Yes/No

Final decision: Reject □ Accept □ Amount granted:

Successful applicant notified:

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Students in India Paste Your Photo Here

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Name

University

Your Email (print clearly and tell us immediately if you change your email):

Grant letter issued: Returned signed:

Funds transferred on: Receipt acknowledged:

Notes:

1. YOUR PERSONAL DETAILS

Full Name: Aliases (if any): Ethnic origin:

Date of Birth Place of Birth Male/Female Married/Single

No. of Children

Mailing Address:

City: Post Code: Country:

Telephone:(country code & number)

Fax: E-Mail:

Details of passport or other travel document:Number:Issuing Authority:Place & Date of issue:

2. PARENTSIf either or both parents are retired or deceased, please give their previous occupation

Father:Name Occupation:Country of residence:

Mother:Name Occupation:Country of residence:

3. STUDENT STATUS:

Delete one of the following:

a) I have applied to:

b) I have been accepted for :

Name of university /college:

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Address of your university/college:

Post Code: Country: Telephone: Email:

Name:

Are you currently enrolled in a first degree (undergraduate) course?

YES/NO

If YES, attach documentation confirming that you are registered as a student.

Are you currently enrolled on a postgraduate degree course? YES/NO

If YES, attach documentation confirming that you are registered as a student.

Do you have a confirmed offer of a place on a postgraduate degree course?

YES/NO

If YES, attach a copy of the offer.

If you cannot attach all the required documents when submitting your application, please explain the reasons in a covering letter; and send the documents as soon as they are available.

Applications without all necessary supporting documents will be rejected.

You may attach further documents if you think they will help your application.

4. DETAILS OF YOUR COURSE:

Title:

Is the course? FULL TIME PART TIME CORRESPONDENCE (Please delete as appropriate)Starting Date: (Month/Year) Expected finishing/graduating date:

(Month/Year)

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What is your main subject of study?

What is the title of your thesis? (If appropriate)

What qualification do you hope to receive from this course, eg BA, BSc, MA, MSc. PhD?

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Name:

5. PREVIOUS EDUCATION

a. Name & location of Secondary School attended:

b. Subjects studied: Examinations passed with dates:

c. Details of College/University attended: Examinations passed with dates:

d. Details of any formal English language tuition/examinations passed:

6. REFERENCES

Names and addresses of people who can comment on your academic ability (one of these must be your current or most recent academic supervisor):

First Referee Second RefereeName: Name:

Address: Address:

Telephone: Telephone:

Fax: Fax:

Email: Email:

Attach at least one written academic reference.

If you fail to give the names of ACADEMIC referees, it will delay consideration of your application.

Names of friends, other students, or relations ARE NOT ACCEPTABLE.

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Name:

7. FINANCIAL INFORMATIONAll applicants must disclose all other financial support. Failure to comply or false statements will result in immediate disqualification. If the exact figures are not known, please estimate how much you will receive.

Eligible candidates may request assistance for tuition, living expenses, medical insurance, books or other academic materials, and transportation to and from the school for the duration of academic year 2011/2012. Costs which were incurred before or will be incurred after this period may not be requested in this scholarship form.

A) WHAT ARE YOUR COSTS?In this section please show all of the costs related to your study for the academic year 2011/2012, even if you have already covered some of these costs. You will be asked to show what you have already covered in the next section.

Please specify the Currency used for all costs ____________________________

1. Academic Fees:

This includes all the fees that you are required to pay to your school or university. If you have a fee waiver, show the full costs before the waiver is deducted.

2. Housing Costs:

This includes rent, electricity and water charges. If you share accommodation, show only your contribution towards the total rent.

3. Living Expenses:

This includes food, drink, clothing, toiletries, laundry and health insurance costs. If you share these costs, show only your contribution to the total.

4. Other expensesa) Books, stationery and essential equipment:

b) Uniform:

c) Passport and visa costs:

d) Daily travel to college/university:

e) Travel for research/academic assignments:

f) Other (Please Specify):

Sub Total (Items 4a-4f)

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5. TOTAL COSTS (Items 1-4):

B) WHAT ASSISTANCE DO YOU ALREADY RECEIVE?

In this section please show all of the financial assistance, assistance in kind (eg free accommodation or food), fee waivers, loans, grants, or discounts you expect to have for the academic year 2011/2012 to help you cover the total costs you have shown in Number 5 above.

If you are not yet sure of the financial support that will be available to you please attach a covering letter to explain who you have applied to for funding, how much you have applied for and when you expect to hear the result.

6. Amount of Scholarship or Sponsorship:

If you do not have a scholarship or sponsorship, leave this blank.

7. Amount of Fee Waiver:

If you do not have a fee waiver, leave this blank.

8. Loans & Grants, including state benefits:

If you do not have loans or grants, leave this blank.

9. Income from Part-Time Work:

If you do not have income from part-time work, leave this blank.

10.Personal Savings:

If you do not have personal savings, leave this blank.

11.Family Contribution:

If you do not have a family contribution, leave this blank.

12.TOTAL PROVIDED BY OTHER SOURCES (Items 6-11)*:

*This section cannot be left blank. You must show that you have some other funds by providing information for some or all of selections 6-11.

FINAL CALCULATION FOR SCHOLARSHIP REQUESTThis section shows the amount of money you are requesting from Prospect Burma for the academic year 2011/2012. This is calculated by subtracting the funds that you already have (shown in No. 12) from the total cost for this period (shown in No. 5).

TOTAL AMOUNT REQUESTED:

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The amount on line 12 subtracted from the amount on line 5.

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Name:

C) DETAILS OF YOUR BANK ACCOUNT:

Name of Bank and full branch address: SWIFT code:*

Name in which account is held:

Account number: Bank clearing code (if any)*:

We prefer that you have your own account, but if you use a friend’s account, be sure they agree.*Ask your bank for the codes needed for international bank transfers

Prospect Burma only offers partial awards; how will you cover the rest of your expenses?

8. BIOGRAPHY:

Give details of your connection with, and dates of residence in Burma and in your present country of residence. Tell us also of your reasons for choosing your course of study.

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9. FUTURE PLANS : This section is very important. The essay must be your own. Candidates submitting identical essays will be disqualified.

We will give preference to candidates studying subjects relevant to the development of Burma. Please use this space to tell us in your own words about your future plans, and how you will benefit Burma. Continue on a separate sheet of paper if necessary and sign it.

Signature…………………………………………………………….Date……………………………

If you are awarded a scholarship, we will ask you to sign an undertaking that you firmly intend to return to Burma when feasible to help your country’s development.

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Name:

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