UCL DENYS HOLLAND SCHOLARSHIP APPLICATION FORM

Please read the accompanying Guidance Notes before completing this application form

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

2) CONTACT DETAILS (If successful, we will inform 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 -
Programme Length Start Date End Date:
      years            
mm/yyyy mm/yyyy
Fee Status (specified in the offer letter) - select -

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

SECTION B

1) FINANCIAL STATEMENT
The Denys Holland Scholarship is intended for students in financial need, those who would be unable to
study at UCL without financial assistance. 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 Scholarships or Value Per Year Duration Details

Grants / Family Support / Part- (GBP £)
time employment plans
                       
                       
                       
                       
                       

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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) APPLICANT’S 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 UCL’s 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 valid UCAS number on page 1 of
this application. Please DO NOT provide the UCAS registration number.

Please email your application and attachment file (if applicable) to: studentfunding@ucl.ac.uk
The email subject should be “Denys Holland Application (Last Name, First Name)”