Electronically and Attach 2 Recent

The EU Scholarship Programme for the Turkish Cypriot community is funded by theEuropean Union and implemented by British Council

ANNEX A

PLEASE COMPLETE ALL PARTS OF THIS FORM

ELECTRONICALLY AND ATTACH 2 RECENT

PHOTOGRAPHS OF YOURSELF

PART A: PERSONAL DETAILS

Family Name:
(as it appears in your valid passport)
Given name(s):
Gender: / Male Female
Date of Birth: / Day ____ Month ____ Year ______
Place of Birth:
*copy of your birth certificate to be
provided with this application and one
of your parents (if applicable) / Town/City:
Country:
Nationality/(ies):
Current valid address
(registered residence)
*copy of any document (i.e. bank or
telephone statement) proving valid address
to be provided with this application
Email Address:
Telephone Number:
Mobile Number:
Address for correspondence:
(if different from the current valid address)
Please indicate if you have any special need that would require us to make special arrangements for you during any stage of the Scholarship Programme (e.g. Dyslexia, Physical disability e.g.hearing, etc. / Yes No
If yes, please specify:

PART B: ACADEMIC, PROFESSIONAL AND PERSONAL BACKGROUND

1. Have you ever been abroad? Yes No

If yes, please tick the boxes appropriately

Tick (√) / Country / Duration (days/weeks/months/years)
Studied abroad
Lived abroad
Worked abroad
Visited abroad for holiday
Other (please specify)

1. Have you ever benefited from a scholarship grant funded by the European Commission?

Yes No

If Yes, please give full details of your scholarship grant:

Academic Year for your scholarship grant:
Country that you studied in:
Name of university/institution:
Subject of study:
Qualification received(if any):

As stated in the guidelines, applicants who have benefited from any scholarship grant under previous EU programmes for the Turkish Cypriot Community are not eligible to apply for another scholarship under this scheme. This includes: the Community Scholarship Programme 2007/08 and 2008/09, the EU Scholarship Programme 2009/10 and the Scholarships for the Turkish Cypriot Community Programme 2010/11, 2011/2012, 2012/2013, 2013/2014, EU Scholarship for Turkish Cypriot Community 2014/15

1. Have you applied for any other scholarships or awards to study in the EU, to be funded by any other institutions or foundations during the last 12 months, or are you intending to apply for such scholarships in the next 12 months?

In the last 12 months: Yes: No:

In the next 12 months: Yes: No:

If Yes, please give details below:

Proposed EU Member State for study:
Name of university/institution:
Subject of study:
Type of scholarship or award:
Duration of award:
Date of award (from – to)

Applicants are not prevented fromapplyingatthesame time forascholarshipfromanotherdonor. However, ifsuchfundingisgranted from any other institution, organisation, university, local or national authorities, and is acceptedbya successful applicant, then he/she will notbeawardeda scholarshipgrantunderthisgrantscheme. An exception may be made ifthe granteecanprovideevidence,thatthe total amount receivedunderthisscholarshipprogrammeand fromanyotherscholarshipdoes notexceedthe actualcostoftheparticipationinthestudyprogramme.(Includingtuition fees, if applicable, and the cost of accommodation and travel).

1. Are you currently studying? Yes No

If yes, please tick ONE section below to indicate where you are currently studying and what course you are doing:

High school: / School:
Town/city:
Country:
Year:
Foundation year: / University:
Course:
Country:
University: / University:
Course:
Country:
Year:
If no, please give details of what you are doing now.

Educational Background

Country / Institution
(school/
University) / Qualification Obtained / Subject / From
(date) / To
(date) / Total Number of years
TOTALNUMBER OF YEARS:

1. Please list all your schools/institutions and qualifications/diplomas/degrees gained, starting with the most recent qualifications.

Please add lines if necessary.

Please attach all relevant documentation to prove at least seven (7) years of study in Cyprus, e.g.official document from the education authority and/or school leaving certificates and/or reports and/or diplomas, university transcripts (if applicable). Non-certified translation in English will be accepted.

1. Cumulative Grade Point Average (CGPA), please provide your CGPA for your school leaving certificate/ diploma and/or transcripts whichever is relevant and attach a copy.

CGPA of your high school diploma or transcript:

PART C: LANGUAGE OF GENERAL ABILITY TEST

1. Please choose your preferred language for the General Ability test by tickingONE of the boxes below:

Language / Tick (√)
English:
Turkish

N.B. You cannot change the choice of your language once you submit your application.

PART D: PROPOSED COURSE OF STUDY ABROAD

1. Please indicate in which EU official language you intend to study. Tick ONE:

Language / Tick (√)
English:
French:
German:
Spanish:
Other (please specify):

N.B. Please note that the Motivation Letter will be written, and the interview will be held, in the same language that is chosen for the programme of study

1. Please indicate the EU Member StateUniversities or equivalent institutionsof highereducation (formally accredited by the authorities of the host country) to which you have applied or are planning to apply. Please give details of the course and the countryin order of preference.

Order of Preference / Full title of the programme / University / Country
1.
2.
3.

Please provide copies of conditional or unconditionalacceptance letters or correspondence as explained insection F.

PART E: DECLARATION BY THE APPLICANT

1. Please insert your name, read the following carefully, print, sign and date the declaration:

I, ______, hereby declare that:

i)I am not a relative of any staff member of EUPSO (EU Programme Support Office) Nicosia, European Commission or British Council Cyprus. Tick √ _____

ii)I have read in full the Guidelines and understand the contents. Tick √ _____

iii)I have completed this application myself, I have not asked another person (agent, family member, etc.) to complete it on my behalf. Tick √ _____

iv)All the information provided in this Application Form is truthful and accurate. I understand thatincomplete, inaccurate or false information may lead to the rejection of my application. I also understand that if any of my declaration is subsequently found to be false I will be disqualified from the process. Tick √ _____

In case of award of a scholarship, I hereby declare that:

v)I will refuse any other scholarships for the same programme and period of study from anyother institutions, organizations, universities or national and local authorities. Tick √ _____

(Thisprovision does not apply if I canprovide evidencethat the total amount received under this grant contract and from any other scholarships does not exceed the actual cost of the participation in the programme (including tuition fee, if applicable, and cost of accommodation and travel).

vi)I am able to attend and complete the programme and there are no health conditions that prevent me from doing so.Tick √ _____

vii)I am not in any of the situations excluding me from participating in contracts which are listed in Section 2.3.3 of the Practical Guide to contract procedures for EU external actions (available from the following Internet address:

Furthermore, it is recognised and accepted that if I participate in spite of being in any of these situations, I may be excluded from other procedures in accordance with Section 2.3.3 of the Practical Guide. Tick √ _____

viii)If recommended to be awarded a grant, I accept the contractual conditions as laid down in the Draft Specific Contract annexed to the Guidelines for Applicants for Academic Year 2015/16. Tick √ _____

USE OF PERSONAL DATA

I will give the European Commission and the British Council as the contracting authority the right to share my contact details with other organisations as necessary for the successful implementation of this Scholarship Programme. Tick √ _____

I am aware that, for the purposes of safeguarding the financial interests of the EU, my personal data may be transferred to internal audit services, to the European Court of Auditors, to the Financial Irregularities Panel or to the European Anti-Fraud Office. Tick √ _____

Any personal data will be processed solely for the purposes of the performance, management and monitoring of this Application by the European Commission or British Council and may also be passed to the bodies charged with monitoring or inspection tasks under European Union law. I will have the right of access to my personal data and the right to rectify any such data. If I have any queries concerning the processing of personal data, I shall address them to the Contracting Authority. I will have right of recourse at any time to the European Data Protection Supervisor. Tick √ _____

Signature: ______Date: ______

PART F: APPLICATION FORM CHECKLIST

This part of the Application form can be handwritten.

Please note thatthis checklist is only a summary and APPLICANTS ARE REQUIRED TO FOLLOW POINT 3 OF THE GUIDELINES AND ANNEX D FOR DETAILED REQUIREMENTS ON THE DOCUMENTS TO BE ENCLOSED.

Before submitting your application, please check that each of the following points is complete, please also tick (√) the boxes as appropriate: / Yes / No
1. / The correct Application form has been used (Academic Year 2015-2016)
2. / The application form has been downloaded from the website and completed electronically.
The information included in the Application form is typed (except part E) and is in English.
3. / PART E of the Application form, “Declaration by the Applicant” has been signed and dated
4. / Copy of the birth certificate of the applicant and one of the parents (if applicable) is enclosed with this application.
5. / Copies of the relevant certificates, student reports, diplomas, university transcripts etc. to prove 7 years of study in Cyprus are enclosed with this application
6. / Contact Details Form (Annex F) is filled in, signed, dated and is enclosedwith this application (hand writing will be accepted, please use capital letters)
7. / Copy of any document proving current valid address is enclosed with this application.
8. / Copy of conditional or unconditional acceptance letter(s) and/or any correspondencebetween the applicant and the university(ies) or equivalent higher education institution(s) is enclosedwith this application.
9. / I understand that any missing documents are to be submitted no later than the deadline of 4 March 2015 at 17.00 hours, Cyprus time.

Signature: ______Date: ______

1