Application form for UT Scholarship

Study details Name UT contact person (fainco): MSc Programme: Track: Personal details Student number: Surname: Given names: Male/Female: Nationality: Address: 1/59 B Sector D, Priyadarshani Colony, Sitapur Road, Lucknow, India Prior degree major : Prior degree minor: Title thesis: Name University prior education :
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Puri Manas Male Indian Postal Code/City: 226021 Country: India Email:
puri.manas@gmail.com

Date of birth:

21-06-86

Ranking home university (if applicable): Work experience:

Name ranking and position

(e.g. Shanghai Jiao Tong, Times Higher Education, The Economist, CHE)

PhD Yes aspirations:

IELTS or TOEFL subscores (if not applicable, please explain): Listening: Reading: Writing: Speaking: Overall band score:

CGPA: UTS amount requested: 20.000

On a scale of:

Checklist enclosed documents 1. 2. 3. 4. 5. Email address two referees (incl. name, title and profession) Motivation letter for request scholarship Grading report of prior degree(s) CV/resume Candidates personal budget

Double-click on the checkbox:

Please indicate whether this concerns a Bachelor or Master Programme

International Office UTS 2012