APPLICATION FOR GOLDSMITHS HUMANITARIAN SCHOLARSHIP 2012/2013

Four Goldsmit s Hum!"it!ri!" S# ol!rs i$s !r% !&!il!'l% to stud%"ts stud(i") *or ! t!u) t M!st%rs d%)r%% !t Goldsmit s+ , o #om% *rom #ou"tri%s !**%#t%d '( ,id%s$r%!d o$$r%ssio"+ $%rs%#utio"+ $oliti#!l or milit!r( stri*% su# t !t t %ir um!" ri) t to $ost)r!du!t% %du#!tio" is d%"i%d to t %mT % s# ol!rs i$ $ro&id%s *ull tuitio" *%%s+ m!i"t%"!"#% !"d !ir*!r%s to !"d *rom t % U.- Pl%!s% !$$l( !s soo" !s $ossi'l%+ *i"!l d%!dli"%/ 1 A$ril 2012INSTRUCTIONS/ Ensure your application and supporting documents are TYPED if possible. If you are unable to type the form, please make sure you write legibly (print in black ink . You must include an E!"I# "DD$E%% on the form (as this is our main method of contact Your reference must be signed, dated and printed on letter&headed paper. Pro'ide ()PIE% of transcripts and certificates, not originals. Please supply them again e'en if you ha'e included them with your course application. You must ha'e already submitted an application for a place on your chosen course. If you would like this form to be sent to you in an alternati'e format, please contact us.

S0CTION A 1 P0RSONAL D0TAILS Sur"!m%/F!mil( N!m%/ First N!m%/ Titl% (e.g. !r*!s + D!t% o* 2irt (dd*mm*yyyy / Cou"tr( o* Ori)i"/ CONTACT 0m!il Addr%ss/

CORR0SPOND0NC0 ADDR0SS Str%%t Addr%ss/ Cit( !"d R%)io"/Cou"t(/ /St!t%/ Post#od%/ Cou"tr(/ INT0ND0D PROGRAMM0 OF STUD3 AT GOLDSMITHS 4u!li*i#!tio" Sou) t (e.g. !" / Pro)r!mm%/Cours% Titl%/ Goldsmit s D%$!rtm%"t/ T($% o* o**%r %ld (if you hold one e.g.
unconditional or conditional /

Pro)r!mm% St!rt D!t%/ A$$li#!tio" r%*%r%"#% "um'%r (,&digits, at the top of your offer letter, if you ha'e
one +

S0CTION 2 1 0LIGI2ILIT3 Pl%!s% %5$l!i" , ( !"d o, (our !##%ss to $ost)r!du!t% %du#!tio" is r%stri#t%d '( t % #urr%"t situ!tio" i" (our #ou"tr(- Dr!, !tt%"tio" "ot o"l( to *!#tors , i# !$$l( )%"%r!ll( to )r!du!t%s i" (our #ou"tr( 'ut !lso to !"( *!#tors , i# !r% o* $!rti#ul!r r%l%&!"#% i" (our $%rso"!l #!s% (box will expand as you type 500 words max*) 6 If you prefer, you may write your statement on a separate piece of paper and attach it to this form. S0CTION C 1 ACAD0MIC AND 7OR. HISTOR3 0DUCATION FROM TH0 AG0 OF 18 %tart with current or most recent, and include professional -ualifications where appropriate
I"stitutio" N!m% 9 Lo#!tio" (city and
country

St!rt d!t%

(mm*yyyy

0"d D!t%

(mm*yyyy

4u!li*i#!ti o" !# i%&%d

(e.g. " #e'els, I., "bitur, .", .%c, !"/..

Su':%#t

O&%r!ll Gr!d%+ GPA or Cl!ss

Possi'l% )r!d% r!")%

(highest 0 lowest e.g. 1&2, "&3, 1445 & 45

0MPLO3M0NT+ TRAINING AND 7OR. 0;P0RI0NC0 6here rele'ant to the programme or scholarship re-uirements
0m$lo(%r "!m% !"d lo#!tio"
(city and country

St!rt D!t%
(mm*yyyy

0"d D!t%
(mm*yyyy

Positio" %ld

L!")u!) % !t ,or<

PRI=0S+ A7ARDS AND SCHOLARSHIPS A7ARD0D FOR PR0>IOUS STUD3/R0S0ARCH 6e may re-uest proof of the information you gi'e below.
N!m% o* Pri?%+ A,!rd or S# ol!rs i$ Pur$os%
6hat was the pri7e, award or scholarship awarded for8

O&%r!ll &!lu% G2@

if applicable

D!t% !,!rd%d Amm/((((B or Dur!tio"

as applicable

S0CTION D 1 P0RSONAL STAT0M0NT

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Pl%!s% %5$l!i" , ( (ou !&% # os%" to !$$l( *or t % $ro)r!mm% id%"ti*i%d i" S%#tio" A !'o&%+ !"d o, (ou %"&is!)% t is Cu!li*i#!tio" !"d (our %5$%ri%"#% o* stud(i") i" t % U. #o"tri'uti") to (our *utur% #!r%%r $l!"s (box will expand as you type 250 words max*) I" , !t ,!(s ,ould (ou o$% to $!rti#i$!t% i" !"d #o"tri'ut% to t % !#!d%mi# 9 so#i!l dim%"sio"s o* li*% !t Goldsmit sD (box will expand as you type 150 words max*) 6 If you prefer, you may write your statements on a separate piece of paper and attach it to this form. S0CTION 0 1 SUPPORTING DOCUM0NTS 3ou MUST !tt!# t % do#um%"ts list%d '%lo,- 7it out t %m (our !$$li#!tio" ,ill '% d%%m%d i"&!lid- Pl%!s% do "ot !tt!# !dditio"!l do#um%"ts su# !s C>s !s t %( ,ill '% disr%)!rd%d *rom (our !$$li#!tio"- I* (ou !r% u"!'l% to o't!i" #%rt!i" do#um%"ts+ $l%!s% $ro&id% !" %5$l!"!tio" o" ! s%$!r!t% $i%#% o* $!$%rPl%!s% i"di#!t% i" t % ri) tE !"d #olum" , i# do#um%"ts (ou !&% %"#los%dPhotocopies of official college and uni'ersity degree certificates and transcripts. "cademic $eference relating to your current or most recently completed course (e.g. from personal tutor , or a professional reference if appropriate. You may submit a copy of your programme application reference if you wish. Co"*irm!tio" t !t (ou !r% %li)i'l%/ I confirm that I ha'e submitted a separate application for admission on my course+ I confirm that I am liable to pay the International rate of tuition fees+ S0CTION F 1 APPLICANTFS D0CLARATION Please read the following statements and sign below to indicate acceptance of these terms I declare that the information I have provided on this form is correct to the best of my knowledge I consent to my data being processed and shared with college staff for the purposes of selection, assessment, payment, reporting and monitoring I understand that if, subsequent to submitting my application, information I have supplied in support of my application is found to be incorrect, Goldsmiths College reserves the right to reject the application I understand that, if awarded a scholarship, I will need to provide a student profile for use in marketing and recruitment materials and make myself available to assist in the recruitment activities of the College I understand that the personal data which I have provided on this form may be stored in paper and/or electronic form in accordance with Goldsmiths College policies on Data rotection !available at" http"//www#gold#ac#uk/data$protection/% and with the provisions of the Data rotection &ct !'(()%
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Name:

Date:

%ignature+ 0MAIL APPLICATIONS/ I* (ou !r% %m!ili") (our !$$li#!tio" to us A,it s#!""%d !tt!# m%"tsB $l%!s% ti#< t is 'o5 to i"di#!t% (our !##%$t!"#% o* t % !'o&% t%rms/