Applicant number

Editing remark

Filled out by the University

I am:
Application form prospective bachelor student

Deutschlandstipendium at Hochschule Fulda bachelor student

prospective master
(Scholarship period: Oktober 1st 2017 - September 30th 2018) student/master student

1. Personal Data

Family name Date of birth

First name Place of birth

Nationality

Gender female male

Contact Adress
E-mail

Street/ house no.

Additions

Postal Code/City

Country

Mobile phone

2. Application Data/Study Data

Matriculation number/Application number

Faculty

Study programme

Starting date of studies

for study beginners and bachelor students only

University entrance qualification Grade

for master students and applicants for a master's programme only

University where bachelor's Grade
degree was acheived

3. Other scholarships
Are your receiving BAfG? (i.e. German federal student support) Yes No

Are you receiving any other scholarships (public or private)? Yes No

If yes:
Name of scholarship programme

Amount of monthly scholarship

Have you applied for any other scholarship? Yes No

If yes:
Name of scholarship programme

1/5
 Applicant number
Filled out by the University

4. Background

Do you/Does your family have a migrant background? Yes No

If yes, please explain briefly:

Have your parents graduated from University? Yes, both One of them No

5. Scholastic Career

Name of school Period (mm/jjjj-mm/jjjj) Degree

6. Vocational training
Name of company Period (mm/jjjj-mm/jjjj) Name of profession

6. Previous studies
Name of University and studies Period (mm/jjjj-mm/jjjj) Degree

7. Previous full-time jobs

Name of company Period (mm/jjjj-mm/jjjj) Name of profession

7. Further Information
Note: Here you have the possibility to give information on military services, community services, stays abroad (over three months) or internships
(over three months) you have done.

Description Period (mm/jjjj-mm/jjjj)

8. Other

Note: Not every curriculum vitae fits into a set form. Is there anything else concerning your career you yould like to let us know? Please feel free to do so here:

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 Applicant number

Filled out by the University

9. Personal data
Note: For study beginners: please answer the following questions with regard to your schooldays. For bachelor students and master students: please answer the
questions with regard to your time at university.

Personal achievements (only honors, awards or scholarships):

Description Period (mm/jjjj-mm/jjjj) oder date

Civic involvement (without payment), e.g. volunteer work, work as a student representative, participation in civil societies,
political associations, religious communities etc.:

Description Period (mm/jjjj-mm/jjjj) Hours per week

Paid part-time jobs/ student jobs:

Description Period (mm/jjjj-mm/jjjj) Hours per week

Child care (especially single mothers and single fathers) or extensive care of a close relative:

Description Period (mm/jjjj-mm/jjjj) Hours per week

Are you suffering from a chronic illness or a disability? Yes No

If yes, how does the illness or your disablity effect your studies at university or in school?

3/5
 Applicant number

Filled out by the University

10. Letter of motivation

Please describe your motivation concerning the Deutschlandsitpendium. Possible key questions are:
Why should I be awarded with a Deutschlandstipendium scholarship?
What are my personal and professional goals?
What are my civic and personal involvements?

4/5
 Applicant number

Filled out by the University

11. Declaration

With my signature I declare that my data is correct and complete.

I am aware, that
- there is no legal claim for the Deutschlandstipendium scholarship and
- that incorrect data can cause the reclaim of all financial support in context of the Deutschlandstipendium.

I commit myself to inform Hochschule Fulda immediately about all changes of my personal affairs that are significant for
awarding the scholarship. Changes can be in particular: double funding (= funding through the Deutschlandstipendium +
through another funding), stay abroad, leave of absence/interruption of studies, day of the last exam, exmatriculation.

12. Data privacy declaration

I hereby declare that the Studienbro/International Office is allowed to inform the selection group for the
Deutschlandstipendium about my grades (university entry qulification, grades gained at Hochschule Fulda and grade of
former bachelor's degree) according to 5 of the "Frderrichtlinien der Hochschule Fulda zur Vergabe von Stipendien im
Rahmen des nationalen Stipendienprogramms vom 26. Mrz 2013" to be able to fulfil the selection process for the
Deutschlandstipendium.

I am aware that my data will be used during the selection process of the Deutschlandstipendium and in case I am awarded
with a scholarship it will be used for the granting of the scholarship. The agreement to the data privacy declaration is
voluntary. In case an applicant does not consent, he or she might not be able to take part in the application process.

I am aware that
- that in case I am awarded with a scholarship my personal data has to be stored for six years,
- if my application is not successful, only my family name, first name, date of birth and adress will be stored for one year. All
other information in cotext with the scholarship will be deleted,
- that my personal data is exclusively used and processed for the selection of suitable applicants and for the implementation
of the Deutschlandstipendium. But scholarship holders have to provide data to the university that are required for the
fulfillment of their duty of disclosure according to 13 Abs. 1 Nr. 1, Abs. 4 of the law of the scholarship programme.

City/Date

Signature

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