MANDELA SCHOLARSHIPfund

Application Form

Please fill in electronically if possible, except for original signature in the declaration.

Personal information
Family name (as mentioned in passport)
First name(s) (as mentioned in passport)
Do you have dual nationality: yes / no. If yes, please indicate which:
Date (dd/mm/yyyy): Place of birth:
female male
Current address (mailing address):
E-mail: / Telephone:
Cell phone: / Fax:
Educational background
Name and address of current University
Contact person (name, e-mail address and telephone number)
Year of Entry
Current Major
(Expected) date of graduation
Degree(s) and /or Certificates Obtained:
Program at LeidenUniversity

Faculty:……… (fill in the name of the faculty)
Or

University-wide student
Tick the appropriate box
Courses
Duration: / From: Until: (dd/mm/yyyy)
Finances
Please describe how you will supplement your scholarship to support yourself and purchase tickets (study abroad)during your exchange/study abroad?
Motivation letter covering the following items
  1. Reason for choosing LeidenUniversity
  2. Reason for choosing the Courses you wish to take at Universiteit Leiden
  3. The relationship between your study at LeidenUniversityand your future career
  4. Explanation of why this scholarship is needed.
-
-If necessary use extra page
Continue motivation:
Survey
Please fill out this short survey. It will help us to update and maintain our information.
Please indicate how you initially learned about the Mandela Scholarship Fund:
 Via World Wide Web
 Via current University
Contact with LeidenUniversity (personal, phone, visit)
Other. Please specify:
Checklist
I have included the following documents with my application (all documents should be in English. Non-English documents should be translated into English and be certified by an official translator)
Admission letter to Study Abroad or exchange atLeidenUniversity
2 original letters of recommendation (of which one should be from an academic staff member)
Transcript of academic records
Up-to-date Curriculum vitae
Letter of motivation explaining why you have applied for the Mandela Scholarship
Photocopy of your valid passport(s)
Copy of results of other scholarship/grant applications
Proof that you can support yourself financially, if the Mandela Scholarship is not sufficient to cover all expenses. Proof can be:
-a student grant from your own country (a letter that states the amount you are getting)
-money of your own (submit a statement from your bank that mentions that you have enough money in your account to cover your costs in The Netherlands)
-a notary statement that states your parents have enough money to support you.
Please provide an explanation if you did not provide the required information with this application. Use a separate sheet if necessary.
Declaration
I hereby declare that the information in this application and the enclosed attachments are true to the best of my knowledge.
Signature:Date:Place*:
*City in which you are signing the document
Please sent all documents by post or scanned e-mail to the following adress
LeidenUniversity
Student & Educational Affairs
Attn. Scholarship department
Pieterskerkhof 6
2311 SR Leiden
The Netherlands
E-mail:

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Mandela Scholarship Fund (2-2012)