Application form for UCM Scholarship All students seeking financial assistance from University College Maastricht must complete this form.

To be uploaded before January 5th, 2018 together with your UCM application. The UCM Scholarship is aimed at highly talented students from outside the EEA (European Economic Area) who wish to follow the Liberal Arts & Sciences programme at University College Maastricht.

1.

Personal Information

Surname First name Date of birth Place of birth Nationality Gender Address (postal address) Zip code & City Country Telephone Email 2.

Female ☐

Male ☐

Home

Mobile

Family Information

Father’s name Occupation Employer Nationality Mother’s name Occupation Employer Nationality Parents marital status

3.

Parental Financial Information

All applicants requesting financial assistance are required to complete this section even if financially independent from parents. Please provide official documentation of financial situation, such as recent (parental) tax return and/or a copy of last pay check(s). Parents’ or guardians combined gross annual income Number of dependent children whose tuition will be paid

€

4.

Other scholarships

Have you applied for any other scholarships? Have you received a decision concerning these applications? If yes, have you been awarded a scholarship? If yes, please name the scholarship Total amount of this scholarship Name of institution granting the scholarship Country of institution granting the scholarship

5.

Yes ☐ Yes ☐ Yes ☐

No ☐ No ☐ No ☐

€

Explanation and comments

If you have other information that might be pertinent to this application for financial assistance, please indicate this below.

6.

Required signature

I hereby apply for the UCM Scholarship and declare that I have completed this form to the best of my knowledge. Date Place Signature of the applicant