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Leyden academy scholarship fund Medical Master Vitality and Ageing

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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



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):



Cell phone:


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


Postgraduate (Master’s) Programme name:


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.


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:

  • Other. Please specify:


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.


I hereby declare that the information herewith enclosed has been provided in good faith.
Signature: Date: Place:

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