LEYDEN ACADEMY SCHOLARSHIP fund
Medical Master Vitality and Ageing
Application Form
Leyden Academy Fund
c/o Leyden Academy on Vitality and Ageing
Rijnsburgerweg 10, 2333 AA Leiden
The Netherlands
E-mail: info@leydenacademy.nl
Website: www.leydenacademy.nl
Please fill in electronically if possible, except for original signature in the declaration.
Personal information
|
Family name (as mentioned in passport)
|
First name(s) (as mentioned in passport)
|
Do you have dual nationality: yes / no. If yes, please indicate which:
|
Date (dd/mm/yyyy): Place of birth:
|
Female Male Titels:
|
Present address (mailing address):
|
E-mail:
|
Telephone:
|
Cell phone:
|
Fax:
|
Educational background
|
Name and address of present / past University or College
|
Year of Entry
|
(Current) Major
|
(Expected) Date of graduation
|
Degree(s) and /or Certificates Obtained:
|
Current or past Study / Current or past Research at University
|
Study
Postgraduate (Master’s) Programme name:
|
Duration:
|
From: Until: (dd/mm/yyyy)
|
|
Research Brief description / Title of research project (max. 25 words) (only for research)
|
|
Please Note:
* Indicate whether scholarships have been granted or applied for and also submit copies of the result.
Motivation letter covering the following items
-
- Aim,
-
- Relationship between the Master Vitality and Ageing and future career,
-
- Explanation of why this scholarship is needed.
-
-
If necessary use extra page.
|
|
Survey
|
|
Please fill out this short survey. It will help us to update and maintain our information.
Please indicate how you initially learned about the Fund:
Via World Wide Web
Contact with Leiden University (personal, phone, visit) OR Leyden Academy
Via our brochures and/or flyers
An education exhibition. Please specify which one:
|
|
Checklist
|
I have included the following documents with my application (all documents should be in English. Non-English documents should be translated into English and be certified by an official translator)
|
-
Admission letter of the Leiden University to the Master programme Vitality and Ageing
-
2 original letters of recommendation (of which one should be from an academic staff member)
-
Up-to-date curriculum vitae
-
Photocopy of your valid passport(s)
-
Copy of results of other scholarships / grants
Please provide an explanation if you did not provide the required information with this application. Use a separate sheet if necessary.
|
Declaration
|
I hereby declare that the information herewith enclosed has been provided in good faith.
Signature: Date: Place:
| |
Yüklə 224 Kb.