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University:
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PROSPECT BURMA
Scholarship Application form 2009
For courses in all countries other than India
♦ Please read the guidance notes carefully; answer ALL questions fully in
English in black ink

♦ APPLICATIONS MUST BE SUBMITTED TO THE ADDRESS SHOWN IN THE

GUIDANCE NOTES BY 31 MARCH 2009

♦ 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: Subject:

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

currency):

FOR OFFICE USE ONLY. DO NOT WRITE ANYTHING BELOW

Registered: New Student: Yes/No

Previous study report received:

Course enrolment confirmed: Offer of Place:

References: Sent for Received Checked

Scholarship C’tee decision: Applicant shortlisted : Yes/No

Final decision: Reject □ Accept □ Amount granted:

Successful applicant notified:

Grant letter issued: Returned signed:

Funds transferred on: Receipt acknowledged:

Notes:
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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: Fax: E-Mail:

(country code & number)
Details of passport or other travel document:
Number:
Issuing Authority:
Place & Date of issue:

2. PARENTS
If 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: Name of university /college:

a) I have applied to:

b) I have been accepted for :

c) I am continuing my studies at :

Address of your university/college:

Post Code: Country: Telephone: Email:

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Are you currently enrolled in a first degree (undergraduate) course? YES/NO

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

student and include a transcript of your most recent year of study.

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)

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. Ph.D?

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5. PREVIOUS EDUCATION

a. Name & location of Secondary School attended:

b. Subjects studied: Examinations passed with dates:

c. Details of College/University attendance: 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 Referee

Name: 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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7. FINANCIAL QUESTIONS

a. EXPENDITURE: How much are your annual academic fees & living expenses? Make
clear the currency used (US Dollars, Pounds sterling, Thai baht, Indian rupees etc)

Currency

Tuition Fees per year

Registration fees

Books & other materials

Other academic fees

Accommodation

Food

Local Travel

Other expenses (specify)

TOTAL EXPENDITURE

b. INCOME: Sources of Financial Support for the academic year. Please indicate whether
the amounts are assured, or if you have made an application.
Include applications to the Open Society Institute (OSI) or other funders.

Details Applied for? Or Amount

Certain?

Own Funds
Parents/relatives/other
individuals
Other scholarships/
grants/ fee waiver

Part time work

Other

TOTAL INCOME

NET FUNDING REQUIRED (total expenditure minus total income) ……………………………

FAILURE TO DISCLOSE ALL OTHER FINANCIAL SUPPORT,

GIVEN NOW OR AT A LATER DATE, WILL RESULT IN
DISQUALIFICATION
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c. Details of your bank account:

Name of Bank and 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.

If we have already awarded you a grant, we will not consider another application
unless we have received a study report from you.
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