Viridian ‘Study4Success’ Application Form

The Viridian‘Study4Success’Award

Viridian Housing is one of the UK’s leading providers of affordable housing.

We currently provide over 16,000 homes, touching the lives of approximately 25,000 people.

Viridian Housing is an established Housing Association that has developed areputation over the last 60 years as an organisation that always cared. They want their housing and services to enable their customers to make the most of their lives.

It is their wish that the Viridian ‘Study4Success’ Award enables thesuccessful applicant to in turn carry this ethos forward to transform the lives of others.

Application forms must be submitted by 5pm on Friday 22nd August 2014

Personal Details
Family Name: / First Name:
Previous Name: / Gender: / Male / Female
Date of Birth: / Title (Mr, Mrs, etc):
Address:
Postcode: / Country:
Tel No: / Mobile:
Email:
Information About Your Programme
Programme Title:
Year Of Entry:
Middlesex Student ID (if known):
Referees: (Written references MUST be on letter headed paper and attached to application)
Name: / Name:
Address: / Address:
Work Email: / Work Email:
Academic History
List all educational institutionsattended after the age of 16, starting with the most recent
Institute name and address / Dates attended / Qualifications gained/pending
Details of any further examination to be taken before commencing degree programme and date of result
Personal Statement
In no more than 500 words, using the space below, tell us about yourself, how you have made a difference to society, why you have chosen to study at Middlesex University and why you merit a scholarship. You may use an extra side of A4 paper, but please observe the 500 word limit.
Declaration
I certify that the above is correct and that I accept that the decision of the Middlesex University Scholarship Awards Committee is final. Terms and Conditions apply. The information collected will be held in accordance with the Data Protection Act of 1998 and all or part of your personal statement may be used for presentation purposes during the Scholarship Ceremony, subsequent publicity and given to the financial sponsor of any special scholarship awarded to you. On the condition of receiving the Study4Success Award the successful student will submit three articles to Viridian. One article will be submitted upon receiving the award at the Middlesex University Scholarship and Awards Ceremony, another during the year on Monday 9th February 2015 and a final article before the student leaves on Monday 1st June 2015, informing Viridian about how their year at Usher Halls of residence has been. I hereby give consent to Viridian to use my image, name and biographical details on Viridian case-studies, promotional materials including websites, social media channels, PR stories, brochures and fliers in the present and future. In giving my consent I understand that these materials and publications will be circulated within and outside the United Kingdom.
Attached:
2 references / Written references MUST be submitted with this application,failure to do so will make your application ineligible for assessment. Tick this box to confirm references are attached.
Copy of Academic
Certificates / Tick this box to confirm copies of any relevant Academic Certificates have been attached.
Copy of Tenancy Agreement / In order to apply for this scholarship you MUST submit a copy of your Viridian tenancy agreement with your application form. Forms received without a copy of your Viridian tenancy agreement will not be considered. Tick this box to confirm that you are a Viridian resident.
Signed / Date:
Please return your completed application by 5pm on Friday 22nd August 2014 to:
Lisa Beatham, Head of Development and Stewardship
at Middlesex University via email: