Name of Agent (if applied via agent):

Address of Agent:

Application number
(as quoted on your offer letter)
500_ _ _ _ _ _

BANGOR UNIVERSITY
INTERNATIONAL RESEARCH SCHOLARSHIP APPLICATION FOR 2010/11 ENTRY

Please complete this form fully and legibly. Incomplete applications will not be considered.

Surname/Family name Other names (in full)

Title (please circle): Male/Female Date of birth: Country of origin: Nationality:

Mr/Mrs/Ms/Miss/Other

Permanent Home Address Correspondence Address (if different)

Telephone: Telephone:
Fax No: Fax No:

E-mail (please provide a valid e-mail address as you will be contacted by e-mail about the outcome of your scholarship application)

State precisely where you have been resident during the last ten years (including periods spent in further and higher educations)

Please insert a tick () in the appropriate box for the programme you have applied for and also the topic of research:

PhD MPhil Topic of Research:

Department/School: Supervisors Name:

Telephone Number: E-mail :

Date on which you wish to enter the University Year __________ Month __________
Have you been awarded or have you applied for another scholarship or grant? (please circle) YES / NO

IF YES
State the name of the awarding authority and the value of the award (and enclose, where possible, official confirmation of such an award)

Please give your reasons for applying for the International Scholarship from Bangor University (This section must be completed.
Your application will NOT be considered if this section is incomplete)

Qualifications Completed (transcripts should be appended and please put OFFICIAL title of the award)

University/Institution attended Degree/Qualification title Classification or Grade Date of Award

(with dates)

Please note: International Scholarships are awarded only to students who have not been offered any other awards, scholarships or bursaries
from Bangor University, its Colleges or Schools. Further Rules and Regulations of the scholarship can be found on our website:
www.bangor.ac.uk/international/future/uwbscholarship.php

I herby agree to conform to the rules and regulations that govern the awarding of scholarships at the University and to submit to the authority
of the Senate in all matters of discipline.

I hereby confirm that the information given on this form is true, complete and accurate and no information requested or other material
information has been omitted.

Signature: Date:

When completed, this form should be sent to Mrs Lisa Jones by post. e-mail or fax (details below).

Post: E-mail (preferred method): Fax:

The International Office, l.a.jones@bangor.ac.uk 0044 1248 383785
Bangor University
9th Floor, Chemistry Tower
Alun Roberts Building, Deiniol Road
Bangor,
Gwynedd
LL57 2UW, UK