Application for Support by students from Pakistan already registered or accepted for a Ph.D.

or equivalent course in a British University or recognised institution of higher education in

the UK.

1. Name:

2. M/F:

3. Date of Birth:

4. Address in Pakistan:

5. Address in the UK (if applicable)

6. Tel no

7. Email address .

8. Details of educational qualifications

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9. UK Education Institution at which the applicant is registered for a post-graduate level course of
study (please send a copy of the registration document)

10. Course registered for

11. Topic of research (This is a key selection criterion. Please include as much detail as necessary
or submit a summary on a separate sheet.)

12. Current status of project / Expected date of completion

13. Reference/Letter of Support: insert here the name, position, and contact address of your
academic supervisor or principal contact within your UK educational institution. You should invite
this person to submit a Letter of Support for your application to the trusts e-mail address,
preferably as a Word attachment on headed paper. The letter should comment briefly on three
aspects of your application: firstly, your academic progress and commitment; secondly, your
personality (why the candidate is worth supporting); thirdly, your financial circumstances (why the
candidate needs supporting)

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14. Purpose for which financial support is required

15. Estimated sum required (maximum 2,000) .................

16. Details of scholarships received or applied for, and of other sources of financial support.
[Applicants will need to satisfy the Trustees that they will have access to sufficient funds from
other sources to enable them to complete their course.]

17. Proposed career on return to Pakistan

..................

Signed.
Date

Please send this completed form (preferably by e-mail) with additional material if desired to:
Tim Butchard, Secretary, The Charles Wallace Pakistan Trust
4, Dorville Crescent, London W6 0HJ, The United Kingdom
E-mail: timbutchard@wallace-trusts.org.uk

March 2009

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