To:

University Koblenz-Landau

Präsidialamt / Referat 13

Rhabanusstrasse 3

D-55118 Mainz

Application Form – Successful Start-Scholarship 2018/19

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Application for Successful Start-Scholarship

Academic Year 2018/19

Master’s program applied for:

Uni-Assist Application Number:

1. Personal Information
Surname: / First name(s):
Date of Birth
(Day/Month/Year): / Place of Birth
(City and Country):
Nationality: / Title: / Mr
Ms/Mrs/Miss
Marital Status: / Single
Married / Children
(if applicable, please specify number and age):
Address
(Street, No.; City, Zip-code; Country):
Email address:
Phone number
(incl. country code):
2. Bank Details (in Germany)
Bank (Name): / Account holder:
IBAN: / BIC/Swift code:
3. Previous Academic Education
Bachelor’s Degree in:
Degree completed at which university:
(Expected) Date of Completion:
Further degrees or academic qualifications
(degree/qualification, academic institution, date of completion):
4. Work Experience (if applicable)
Name and address of company / Employed
from ___
until ____ / Short job description (max. 200 characters)
5. Financing your studies at the University of Koblenz-Landau
How much money would be at your disposal per month? / €
Income from a job / € per month
Financial support from others (parents, relatives, spouse…) / € per month
Scholarship/support from other organisation/institution / € per month
If yes, from which organisation/ institution:
When does the scholarship/ support end?
Other sources of income / € per month
Will your financial situation change within the next 6 months? / Yes No
If yes, please specify why. How much money will you have at your disposal then?
€ per month
Have you applied for any other scholarships? / Yes No
If yes, for which have you applied?
When will you be informed of the outcome?
Amount of scholarship:
6. Statement
Please write a short statement (max. 2000 characters) why you are applying for the scholarship and why you should be selected for the scholarship.

Please hand in the following documents together with the application form:

Copy of the Acceptance Letter of the master’s program

CV (max. 2 pages)

Photocopy of your passport

Please note that the application cannot be processed and considered for the scholarship if any documents are missing.

I herewith confirm that the information given in this application is correct and complete to the best of my knowledge. I agree to inform the International Office immediately if there are any changes with regards to my personal details and/or financial situation during the application period or (if applicable) until the end of the scholarship payments.

Application Form – Successful Start-Scholarship 2018/19

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I know that false or incomplete information given intentionally – especially regarding my financial background - can lead to the immediate termination of the scholarship.In this case, any scholarship instalments which were paid up to that point will be reclaimed by the university.

Application Form – Successful Start-Scholarship 2018/19

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Place and Date

(Original) Signature

Application Form – Successful Start-Scholarship 2018/19

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Point of contact for enquiries:

WelcomeCenter Landau

International Office

University of Koblenz-Landau

Email:

Application Form – Successful Start-Scholarship 2018/19

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