/ Application for Scholarship
2017
Please complete the entire form in English and return together with other required documentation to:
British Alumni Society
(Fundacja British Council)
Ul. Koszykowa 54
00-675 Warszawa / PHOTO

Spaces in the application form can be enlarged by the applicant, as necessary.

SECTION 1 – STUDENT’S PERSONAL INFORMATION (all sections to be completed)

FAMILY NAME / FIRST NAME(s) / SEX (M/F)
DATE OF BIRTH (Day/Month/Year) / PLACE OF BIRTH
HOME ADDRESS
TELEPHONE NUMBER / EMAIL
HOW DID YOU HEAR ABOUT THE BAS SCHOLARSHIPS SCHEME?

SECTION 2 – PARENTS’ OR GUARDIANS’ INFORMATION

FAMILY NAME
FIRST NAME (father) / OCCUPATION
FIRST NAME (mother) / OCCUPATION
PERMANENT ADDRESS OF PARENTS/GUARDIANS (If different from Student’s home address listed in Section 1)
TEL NO:
Father’s daytime phone
Mother’s daytime phone / E-MAIL
E- MAIL

SECTION 3 – PRESENT SCHOOL

NAME AND ADDRESS OF SCHOOL / STARTING YEAR
PRINCIPAL’S NAME / PHONE NO / E-MAIL

SECTION 4 – WHERE DO YOU APPLY

Tick the appropriate box for each school you would like to be considered for. You may tick more than one or even all! Empty lines are left for schools which may make an offer at a later date

Abbots Bromley (boys)
Bedstone College (girls)
Berkhamsted School (boys)
Bruton School for Girls (girls)
Cranleigh School (boys/girls)
Ellesmere College (boys )
Hurst College (boys/girls)
Langley School (girls)
Mayfield School (girls)
Windermere School (boys/girls)
Wrekin College (girls)
Except for Mayfield and Bruton School for Girls all schools are coeducational but the school expressed preference for a boy or a girl

SECTION 5 – ACADEMIC INFORMATION

1.  NAME AND ADDRESS OF MIDDLE SCHOOL ATTENDED
2.  RESULTS OF MIDDLE SCHOOL EXAMINATION (GIVE PERCENTAGE IN EACH PART) AND AVERAGE GRADE ON THE LEAVING CERTIFICATE:
1. POLISH LANGUAGE…………………………….HISTORY AND SOCIAL SCIENCES…………………………..
2. MATHEMATICS………………………………….NATURAL SCIENCES ……………………………………………
3. YOUR AVERAGE ON THE LEAVING CERTIFICATE (do not include grades for behaviour) ………………..
3.  LIST ALL SUBJECTS YOU STUDY IN YOUR PRESENT SCHOOL AND YOUR RECENT END-OF-TERM GRADES RECEIVED FOR EACH SUBJECT
1………………
2………………
3………………
4………………
5………………. / 6………………
7………………
8………………
9………………
10……………... / 11……………..
12……………..
13……………..
14……………..
15……………..

I certify that those end of terms grades are accurate.

Signature of the School’s Principal:

SECTION 6 – STUDENT’S PROFILE

.
1.  List foreign languages you know and describe your level of competence (fluent, good, intermediate, beginner):
2.  Describe any special achievements you would like the Selection Committee to know about:
3.  Do you know what you would like to study at university ? Tick the right answer YES NO NOT SURE
If YES, what would you like to study?

SECTION 7 – DECLARATIONS

I declare that the information provided in this form is accurate and complete / SIGNATURE OF THE STUDENT
………………………………….
We declare that we fully approve of our son’s / daughter’s application for a Sixth Form scholarship in the UK and we have discussed all important aspects of such a commitment. / SIGNATURE OF PARENTS/GUARDIANS
………………………………….
We have been informed that schools may require additional statements regarding family income. In the event of our son / daughter being nominated for a scholarship, we will present required documents to the authorised member of the BAS Management Board. / SIGNATURE OF PARENTS/GUARDIANS
………………………………….
I certify that ………………….……. …………………….is a student of my school. / SIGNATURE OF PRESENT SCHOOL’S PRINCIPAL AND THE SCHOOL STAMP
…………………………………..

SECTION 8 – PERSONAL STATEMENT

In no more than 350 words please explain why you think you would be a good candidate for a two-year Sixth Form scholarship in a UK Boarding School