Application FormPlease complete and submit this formelectronically.

STRICTLY CONFIDENTIALIf this is not possible, contact us (see end of form)

and use black ink to complete form.

PERSONAL DETAILS

Surname: / Forenames:
Term Address (if known):
Postcode:
Telephone:1
2
Email:
Dates at this address: / Out-of-Term Address:
Postcode:
Telephone:1
2
Email:
Dates at this address:
Male/Female(please mark as appropriate)
Date of Birth:
UCAS Applicant Number: / Do you need a work permit to work in the UKYes / No
Do you hold a full UK driving licence: Yes / No
If No when do you expect to take a driving test?

SCHOOLS/COLLEGE ATTENDED SINCE THE AGE OF 13

Name of School / College: / Address: / From: / To:
GCSE (or equivalent) EXAMINATIONS completed

(if more than 10, please state the 10 most appropriate)

Subject: / Date: / Grade: / Subject: / Date: / Grade:

GCE A-LEVEL / AS-LEVEL EXAMINATIONS (or equivalent)

Show grades as Attained (A) or Predicted (P) (See example in italics below)

Subject:
History / Examination Board:
AQA / AS-level grade:
B (A) / Date:
06/05 / A-level grade:
A (P) / Date:
06/08
ABOUT YOU
What work experience do you have (including vacation, part-time or voluntary work)? What skills have you acquired as a result?
(maximum 300 words)

YOUR APPLICATION

Why do you want to be a Civil Engineer? What research have you done to confirm this interest? (maximum 300 words)
Why do you think that your application should succeed? Please include in your answer the attributes you will bring to the Scheme, the benefits the Scheme will offer you and your thoughts on how the Scheme benefits the civil engineering profession.
(maximum 300 words)
HOBBIES / INTERESTS / REFEREE
Please list your hobbies / interests. / Please give the name and address of a person who is familiar with yournon-academic achievements/activities to whom we can write for a confidential reference.
CIVIL ENGINEERING
Discuss your skills and interests with regard to becoming either a consultant or a contractor.
(maximum 500 words)
Identify one relevant area in which Civil Engineering can significantly improve our society. Discuss thepotential impact of theissue and how the industry may need to adapt to recent challenges. (maximum 300 words)
REPORTON CIVIL ENGINEERING PROJECT & POSTER (only for pre-selected applications)
If your application is pre-selected, you will be invited to attend the interview day in Central London. In this case, you will need to send us one week before the event a short report (2 pages) and bring on the day a A3 poster on ‘My Ambition in Civil Engineering’ to give a 3 min presentation.
(a) For the report, choose a local civil engineering project that you are familiar with. Explain what it is and the processes involved in its designand construction, i.e. how does it work and how is it being built? Please include sketches and diagrams if appropriate. We are less interested in web based research, instead youmight visit the site or talk with the engineering staff.
(b) For the poster on ‘My Ambition in Civil Engineering’, this should be about something small or large that you would like to achieve within your career. You will receive more information on this nearer the time of the interview.
I confirm that, to the best of knowledge and belief, the information provided on this form is complete and correct. I understand
That omitting or misrepresenting any facts may subsequently lead to a scholarship being refused or terminated.
Signature: Date:

Thank you for completing this application form. Please email to: