UCL DENYS HOLLAND SCHOLARSHIP APPLICATION

FORM
Your application can only be considered if you have applied for admission through UCAS
and have a valid UCAS number.
Please read the accompanying General Notes & Guidance Notes before
completing this application form.
Please complete ALL sections even if only entering not applicable (n/a).

SECTION A
1) PERSONAL DETAILS
Surname/Family Name
First Name/s
Title - select -
UCAS Application Number UCL Student Number (if
(mandatory) known)
Nationality
Age next from beginning
Date of Birth dd/mm/yyyy years
of the course

2) CONTACT DETAILS (If successful, we will contact you by email):

Email Address
Mobile Phone

3) CORRESPONDENCE ADDRESS (Please inform us via email if this address

changes):
Street Address
City
County/Province
Country of Domicile
Postcode
Telephone incl. area code

4) COURSE OF STUDY AT UCL

Qualification Sought
BA, BSc, BEng, MEng, MSci etc.
Programme/Course Title
UCL Department/Institute
Method of Study - select -
Admission/Enrolment Status - select -

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 End
Programme Length Start Date
years mm/yyyy Date:
mm/yyyy
Fee Status (specified in the offer
- select -
letter)

5) PAST/CURRENT PRIZES, AWARDS, AND SCHOLARSHIPS

Please provide evidence of the information provided below (see Guidance Notes)
Name of Prize, Award, or Details Date awarded
Scholarship What was the prize, award or (MM/YY)
Please list only those awarded on the scholarship awarded for? e.g. academic from/to
basis excellence
of academic merit/achievement

SECTION B
The Denys Holland Scholarship is intended for students in financial need, those who would
be unable to study at UCL without financial assistance.

1) FINANCIAL STATEMENT
Please give full details of your current financial circumstances, an outline of the
funding you have already secured and how this scholarship would contribute to your
financial plan for studying at UCL.
This text box will expand. You must include a word count at the top of the statement - 500 words
max

2) OTHER FINANCIAL SUPPORT

The Denys Holland Scholarship may not be sufficient to cover the full cost of study
including tuition fees and living costs. Please use the table below to explain how you
plan to cover the costs of your studies at UCL. If you have been offered a scholarship
from external funding body or any other financial assistance for your study at UCL, please
also scan the letter notifying you of your award (see Guidance Notes).

Loan / Other Value Per Duration Details

Scholarships or Grants / Year (GBP
Family Support / Part- )
time employment plans
2


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 3) PERSONAL STATEMENT
Professor Denys Holland, in whose memory this scholarship was created, took a keen
interest in students extra-curricular activities as well as in their academic progress.
One of his principal concerns was that students entered fully into college life. Please
comment on your general interests, your achievements so far and your aspirations
for the future, and state how you would make use of the activities offered by UCL and
the Student Union.
This text box will expand. You must include a word count at the top of the statement - 500 words
max

4) APPLICANTS DECLARATION

Your application will not be valid unless this section is signed and dated:
By submitting this application to UCL on:

(Submission date)

I,

(Name)

I declare that:
To the best of my knowledge, the information on this application is accurate and complete. I understand
that my application is valid only if all required information is provided and all required supporting
documents (which will not be returned to me) are enclosed.
I agree to inform the UCL Student Funding Office (studentfunding@ucl.ac.uk) immediately of any other
scholarships, grants or awards I am offered or awarded (by an external sponsor/institution, other offices
within UCL or my admitting department) subsequent to submitting this application, and to provide
details and proof of their details if requested. I understand that any additional funding awarded from
another source may be taken into account in the calculation of any scholarship I may receive.
Data Protection Act 1998: I agree to UCL processing personal data contained on this form or other data
which UCL may obtain from me or other people or organisations while I am applying for funding. I agree
to the processing and disclosure of such data for any purposes connected with my studies or my
funding while on UCLs premises or for any other legitimate purpose, including the compilation of
statutory statistical and personal returns that UCL is obliged to make to government or other agencies.

Type name (this will be taken as your signature)

UCL and the member of the Denys Holland Scholarship Committee will use
this application as well as your UCAS application to come to a decision. Please
make sure to provide your UCAS number on page 1 of this application.

Save your application file as either a PDF or Word Document named (Last
Name, First Name) Denys Holland Application. Save your attachment file (if
applicable) as either a PDF or Word Document named (Last Name, First
Name) Denys Holland Attachment not exceeding 5MB.

Please email your application and attachment (if applicable) to:

studentfunding@ucl.ac.uk 4
The email subject should be Denys Holland Application (Last Name, First
Name)