Application Form for the Access To

Application Form for the Access To

Application Form – Deadline for applications 31/03/2015

1. Personal details
Current Student ID(if relevant) / Date of Birth (dd/mm/yy)
Title(Mr/Mrs/Miss/Ms etc.) / Sex F M
Forename / Surname
Term time UK Address(if a current student) / PermanentHome Address (if different)
Dates / Postcode / Postcode
Phone Number (Home) / Phone Number(Mobile)
Phone Number (Work) / Email Address
Full postcode for the address that you lived at on your 18th birthday
Nationality / Ethnic origin
2. Course details
Title of Masters course you are applying for: / Qualification
Faculty/School: / Full time / Part time: / If part time, specify number of credits you are studying
Are your course fees being paid in part or in full by your employer or other sponsor – If yes please indicate amount
Have you applied for a course at another university? / Yes
Name of Sponsor
Amount

Yes / No

No
3. Details of your Undergraduate Course
Qualification / Subject / Expected Class*
Dates of attendance / Start / Completion

Acceptance on a Masters course will be subject to attaining the University’s entry requirements for that course.

4. Meeting Criteria (Stages 1 and 2)
To apply for a scholarship you must meet all of the following stage 1 criteria:
  • progressing from an undergraduate course in the UK for which you were charged the higher tuition fee applying since 2012-13;
  • starting a masters level full-time or part-time course for a maximum of two years;
  • domiciled in the UK or European Union (EU) and not charged international rate fees;
  • not already qualified at masters level;
  • from a group that is under-represented among the UK Taught Masters population - see the widening participation criteria below
I confirm that I meet all of the above criteria
Stage 2 Widening Participation Criteria
Please tick any of the following statements that apply to you (explanations of acceptable forms of evidence for each statement can be found in the Notes for Guidance)
1 I was in receipt of a maintenance grant as an undergraduate student
If yes please enter the value for each year the grant was awarded
Year: Amount: Year: Amount: Year: Amount:
2I received a Disabled Students Allowance during my undergraduate study and/ or I am registered disabled
3As a child/ young person I was in Local Authority Care or supported by the Foyer Federation (if ticked please provide evidence of dates and duration)
4I was the first in my immediate family (excluding siblings) to enter Higher Education
5 I have caring responsibilities for an ill or disabled family member
6 I was resident in one of the most deprived areas of the country, or from an area from which it is unusual to attend university on my 18th birthday

Please provide a typed statement of no more than 500 words that describes how the award of a Scholarship would make a difference to your future– this should include information about how you have overcome barriers to education and why you are deserving of this award.

5. Declaration
  • I declare that the information that I have given on this form is correct and complete to the best of my knowledge.
  • I understand that giving false information will automatically disqualify my application and may also
    lead to disciplinary procedures resulting in possible exclusion from the University. I further undertake to repay any grants obtained by me as a result.
  • I have read and understand the Notes for Guidance.
I understand that
  • The Coventry University Taught Masters Scholarship Scheme is a competitive award and meeting the criteria does not guarantee success. The decision of the selection panel is final;
  • The Coventry University Taught Masters Scholarship Scheme is only available to students undertaking postgraduate study who meet the full eligibility criteria;
  • I must provide documentary evidence of my situation with my application and thatincomplete applications or those submitted without suitable evidence will not be considered;
  • The Coventry University Graduate Alumni discount of £500, for Coventry undergraduates applying for postgraduate study forms part of the Scholarship award of £10,000 if my application for Scholarship is successful;
  • The information I have provided in this application will be reviewed alongside my application for postgraduate study;
  • The University reserves the right to withdraw a scholarship from anyone who is found to have misled the University about any aspect of their eligibility and seek repayment of any monies already paid by appropriate means.

Your name (CAPITALS) / Your signature / Date

Please return this application form and supporting scanned evidence (you may be asked to provide the original documents at a later stage) by email to .

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