National Express Scholarship Application Form (HEALTH) 2017-2018
Deadline to apply: Friday 27 October 2017
Please note there are only 10 bursaries available so please make sure your application is the best it can be as it will be a competitive process.
1. Personal detailsStudent ID: / Age:
Date of birth:
First Name(s): / Surname/Family Name:
Home Address:
Post code:
Term Time Address:
Post code:
Phone Number – Mobile:
University email address: / Personal email address:
2. POLAR Group (postcode)
Please which group your post code is in (see guidance notes) / 1 2 3 4 5
3. Household Income
What is the household incomefor your home address?
(this must be £35,000 or belowfor you to be eligible for a scholarship and we will need proof of income) / £
Are you from a single parent household? / Yes No
Are you the first in your immediate family to go to university? / Yes No
4. Other scholarships
Are you in receipt of any other scholarships? / Yes No
If ‘yes’ please name the scholarship:
5. Course Details ( this must be one of the courses listed in the guidance notes)
Course title:
Reasons for applying
The aim of the National Express Foundation programme is to support students with challenging personal and financial circumstances and in doing so enable them to advance their education. Please bear this in mind when answering the following questions.
6. Why have you decided to study a health related degree?7. Why are you applying for a National Express scholarship? Tell us about your particular needs and circumstances
8. How do you intend to use the money if you are successful? Please note the bursary cannotbe usedjustfor travel expenses.
9. What are your goals for the thisyear and how will this scholarship help you to achieve them?
Another aim of the National Express Foundation is to provide grants to charitable and communitygroups for projects which support children and young people and promote cross-community cohesion and understanding
10. Have you ever done any charitable/volunteering work in your local area?Yes No
If yes, please name the charity or voluntary group and describe what you did and the people you worked with
or helped?
Signature………………………………………………………………………….Date………………………………......
EQUAL OPPORTUNITIES MONITORING FORMPlease answer all 5 questions putting a in the relevant boxes
- Gender
Male
Female
Transgender
- Age
Under 21
Over 21
- Disability
I have a disability
I do not have a disability
I prefer not to say
If you said you have a disability, please choose from the categories below.
Physical
Sensory (sight, hearing)
Learning (dyslexia)
Mental health
Other (please state)
- Ethnicity
White
Black
South Asian
Chinese
Mixed
Other Asian
Other
Prefer not to say
- Access to information
How did you find out about the National Express (health) scholarships?
HLS Faculty University student portal
Student Centredirect email
WebsiteOther (please state)
Please email your completed form to by Friday 27 October 2017
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