UCD Widening Participation Scholarship Programme 2016
Application Form
All information provided in this form is treated in the strictest confidence and will not be used for any purposes other than to assess an application for this scholarship.
Application for DARE, students with disability, Mature and FETAC
Your details:Your name
UCD Student Number
Programme of Study
Telephone
Address
Further information (please tick as many as are relevant to you):
DARE
HEAR
Student with a disability (but not DARE)
FETAC
Mature
Other (please state)
Section A:
Please describe the achievements / responsibilities you are most proud of (e.g. involvement in sports, community, school or education, volunteering and charity, family commitments.
Section B:
Please describe any family, community, financial or personal circumstances / barriers that impact on your financial situation and your ability to participate fully in UCD life.
Section C:
Please use this space to describe why you are seeking a scholarship and how it will benefit you. Please describe any other funding you will receive or have applied for, and any other efforts you have made to secure financial support / income.
Section D:
Please use this space to tell us why you have chosen your degree course, and what your plans are during your time in UCD, and also on graduation from UCD
Section E:
Income Details
Please tick which best describes your circumstances
ð I am a student with a disability and am registered for supports with UCD Access and Lifelong Learning
Please state disability ______
ð I am a student with a disability and am not registered for supports with UCD Access and Lifelong Learning
Please state disability ______
ð I am a mature student in my own household
ð I am a mature student living with my parents
ð I am not a mature student
ð I am in the care of the HSE
Section E continued
Mother / guardian
(if relevant) / Father / guardian
(if relevant) / Myself
Income from employment (e.g. PAYE – salary, wages, fees) / P21 for 2015
Income from self-employment / Notice of Assessment for 2014
Payments from the Department of Social Protection:
Please tick relevant payment:
ð Unemployment Benefit
ð Unemployment Assistance
ð Widows Pension
ð Deserted Wives
ð One Parent Family Payment
ð Family Income Supplement
ð Disability Benefit
ð Disability Allowance
ð DSP – Pension Payment
Please give details:
______
ð Other DSP payment:
Please give details:
______/ Social Welfare Statement for 2015
& P21 2015 / NOA 2014 if applicable
Scholarship income
(e.g. Department of Education, Community, Corporate)
Please give details:
______/ Letter confirming Scholarship
Any other income:
Please give details:
______/ Letter / documentation confirming income
Section F:
College Budget
Income / € per monthMaintenance Grant (from SUSI)
(please estimate if you have not yet been notified of your award – use studentfinance.ie to guide you)
Access Grant
Other Scholarship
Family Contributions to Living and other Course Costs
Income from Part-time Work during Term-time
Income from Vacation Work / Savings
State payments (eg. BTEA, Rent Allowance, Disability payment)
Total
College Expenditure / € per month
Tuition Fees (including student levy)
College Accommodation / Rent / Contribution to Home
Utilities (Water, Gas, Electricity, Oil or Solid Fuel)
Phone credit
Food and Household Shopping (include any food or drinks bought on campus)
Travel (including public transport & car running costs)
Course Costs (e.g. stationery, books, laboratory equipment, field trips)
Toiletries
Loan repayments
Clothing
Social life expenses
Sport / hobby expenses
Other:
Total
Section G:
Terms and Conditions
· This a private scholarship funded through UCD Foundation.
· Scholars will be paid in two instalments each year by electronic transfer.
· These scholarships are tenable for the duration of the primary degree programme undertaken, only in UCD.
· A student can only hold one UCD scholarship. In the event of a student qualifying for more than one scholarship, the scholarship of the greatest value will be awarded. UCD Access and Lifelong Learning scholarships are not open to holders of Department of Education Scholarships.
· Awarding of this scholarship will not affect entitlement to the Student Grant administered SUSI.
· The students who are awarded scholarships are required to pay any fees due to the University. Failure to do so may results in the withdrawal of the scholarship.
· Scholarships cannot be deferred.
· As this is a private scholarship, successful candidates will be asked to provide a short annual report and photographs, extracts of which will be used in publicity materials.
· If a student has to repeat a stage UCD Access and Learning scholarship will suspend the scholarship for that year and will resume once the student progresses. Academic performance will be monitored and support provided if necessary.
· UCD Access and Lifelong Learning reserves the right to withdraw the scholarship should a student continually fail to complete the academic standards of their programme, or if they face disciplinary proceedings within UCD.
· Applicants must have a legal entitlement to remain in Ireland to complete their proposed course of study. The onus rests with the applicant to satisfy the University in this regard.
· UCD Widening Participation Scholars will be encouraged to act as role models within UCD and their local community.
Application Declaration:
The information provided in this application was written by me, the applicant.
I have answered all sections honestly and in good faith.
I have read and agree to the terms and conditions of this scholarship.
Signature of Applicant: ______Date: ______
Return your completed application with supporting documents to:
Widening Participation Scholarship Programme
Scholarship application
UCD Access and Lifelong Learning Centre
Level One, James Joyce Library Building
UCD, Belfield, Dublin 4
Closing Date is strictly 30th September at 5pm.
Incomplete or late applications will not be assessed by the Scholarship Committee
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