Application form for UCM Scholarship

All students seeking financial assistance from University College Maastricht must complete this form.

To be uploaded before January 5th, 2016 together with your UCM application.
The UCM Scholarship is aimed at highly talented students from outside the EEA (European
Economic Area) who wish to follow the Liberal Arts & Sciences programme at University College Maastricht.

1.

Personal Information

Surname
First name
Date of birth
Place of birth
Nationality
Gender
Address (postal address)
Zip code & City
Country
Telephone
Email
2.

Female

Male

Home

Mobile

Family Information

Fathers name
Occupation
Employer
Nationality
Mothers name
Occupation
Employer
Nationality
Parents marital status

3.

Parental Financial Information

All applicants requesting financial assistance are required to complete this section even if financially
independent from parents. Please provide a copy of last pay check(s).
Parents or guardians combined gross annual income
Number of dependent children whose tuition will be paid

4.

School Financial Information

If your current school can provide any information about your financial situation, please indicate
this below.
Information about financial situation sent separately

5.

Other scholarships

Have you applied for any other scholarships?

Have you received a decision concerning these applications?
If yes, have you been awarded a scholarship?
If yes, please name the scholarship
Total amount of this scholarship
Name of institution granting the scholarship
Country of institution granting the scholarship

6.

Yes
Yes
Yes

No
No
No

Explanation and comments

If you have other information that might be pertinent to this application for financial assistance,
please indicate this below.

7.

Required signature

I herewith apply for the UCM Scholarship and declare that I have completed this form to the best of
my knowledge.
Date
Place
Signature of the applicant