Postgraduate Application Form

For The Queen Mary/Pakistan Capacity Building

Scholarship Scheme 200 !ntry
Completing "our Application
1. Read the instructions on the form carefully as you complete your application
2. Please type or complete the form using #lack ink
3. Please provide the documents in the checklist below
4. Please return completed application form and all documents to:
s !ngeliki Polatou
"he #raduate !dmissions $ffice
%ueen ary& 'niversity of (ondon
ile )nd Road
(ondon
)1 4*+
'nited ,ingdom
-. .f you re/uire assistance please contact us on 04412322 4552 --33 or via email: admissions6/mul.ac.uk or
a.polatou6/mul.ac.uk
$ocument Checklist
Please tick if
provided
1 7 Completed Application Form
2 7 Transcript
Please provide a transcript of your degree1s3. .f you have not yet completed your degree please provide a
transcript of results achieved to date
3 7 T%o &e'erences
Please provide two references from your previous academic institution. .f you have left university it is
acceptable to provide one academic and one employer reference. Please enclose the reference letters
with this application.
4 7 Proo' o' !nglish (anguage A#ility
Please provide evidence of )nglish language ability 7 .)("+& "$)8(& or other acceptable proof 7 please
see www./mul.ac.uk9international for details
)&
.f you will be providing evidence of your )nglish language ability at a later stage& please tick here. Please
note that the deadline for receipt of this document is !pril 1
st
2212
- 7 &esume/Curriculum *itae +C*,
Please provide a recent resume
: 7 Statement o' Purpose
;our statement of purpose should e<plain why you want to study your proposed course and how it will
help your life and career. "his should be one side of !4
4 7 &esearch Proposal
;ou should include a research proposal. Please see separate notes for guidance
1
2
Personal details
-ender. ale 8emale

$ate o' #irth 1dd:mm:year3: /ationality.
Please tick appropriate title =r r rs s $ther:
-i0en /ame. Family /ame.
Please provide your name as on your passport
.f the name which appears on your official documents e.g. transcripts is different to that given above enter your former name in the bo<es
provided below. ;ou will be re/uired to produce documents authenticating any change of name.
Former gi0en
/ame.
Former 'amily
name.

*ote: correspondence will be sent to your correspondence address. ;ou must inform us every time your address changes.
Permanent home address Address 'or correspondence



Postcode. Postcode.
Telephone /um#er. Telephone /um#er.
Fa1 /um#er. Fa1 /um#er.
)mail

"ou must provide a personal active email address& this is essential for you to be kept informed about your application.
Course details
Study #y &esearch
Area o' study /ame o' super0isor
+i' kno%n,
$epartment Start date Full/part
time
Official use only
Programme Code

For office use only
=ate received =ate logged !pp *o. 8ee status > $ ) %
Place of birth: *ationality: =omicile:
=ecision: R ' ? Reply: 8 = ?onfirmation: R ! ?
>ighest
%ual
%uals
@erified Ais sent
"rans to
+R+
+pecial
*eeds Prev %
3
Pre0ious education
Please provide details of your educational history& stating your most recent institution first. ?ontinue on a separate sheet if necessary.

Title +eg BA2
BSc2 MBBS,
Main 'ield o' study /ame and location o'
institution+s, attended
$ates o' study
+'rom3to,
&esults $ate o'
Quali'ication






!nglish (anguage Pro'iciency
Please give information regarding the level of your )nglish language proficiency. ?ontinue on a separate sheet if necessary.
Title o' Quali'ication
1eg .)("+& "$)8( etc3
/ame and location o' institution/test centre
attended
&esult $ate a%arded/to #e
a%arded

!mployment 4istory
.f you have been in paid or voluntary employment& either during your studies or since graduating from university& please provide details
including a brief description of your main duties and responsibilities. Please continue on a separate sheet if necessary.
5o# Title !mployer6s /ame and
(ocation
$ates
From 7 to
Brie' description o' main duties and
responsi#ilities



4
Finance
Be need detailed information about your areas of residence over the past four years to assist us in assessing your status for the purpose
of paying fees.
/ationality Country o' #irth
Area o' permanent
residence

.f you are not a Critish citiDen but you do reside permanently in the 'nited ,ingdom& please give details of your immigration status& for
e<ample& asylum seeker& recognised refugee& granted e<ceptional leave to enter or remain etc. Please attach certified copies of relevant
>ome $ffice documents
Please e<plain how you will finance your living e<penses in the ',

Please give details of any scholarships or grants you are applying for or have already secured:
"he %ueen ary9Pakistan ?apacity Cuilding +cholarship
$isa#ility
!ll applications are considered on academic merit in accordance with the ?ollegeEs commitment to promoting e/ual opportunity
applicants. .t would assist us in offering you appropriate advice if you would give brief details of any disability or special re/uirements
you have provided below:

! detailed guide outlining current policy and provision for studentEs with special needs is available from the =isability ?oFordinator&
!dmissions $ffice or the ?ollege Beb site. Please contact us if you would like a copy.
.f you would like to discuss your needs before submitting this application& you can talk in confidence to the =isability ?oordinator on 044
12322 4552 3132.
Pre0ious Queen Mary Students
>ave you pre0iously attended any course of study 1undergraduate& postgraduate or associate9occasional3 at %ueen aryG .f yes&
please give details

5
$eclaration
!ll applicants must read and sign the following declaration:
. certify that the statements made by me on this form are correct. . understand that the ?ollege reserves the right
to withdraw any offer it may make& should any statement in this application prove to be false.
. confirm that& if admitted to the ?ollege& . will conform to all ?ollege Regulations.
. understand that the ?ollege reserves the right to withdraw or alter any course at any point before the start of the
academic year in which that course is due to be offered.
+igned:HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH =ate: HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH
6
)ptional Questions 1"hese /uestions are for internal marketing purposes and will not be considered
when assessing your application.3
4o% did you 'irst hear a#out Queen Mary8

9hich other institutions ha0e you applied to8