Part 1: Your personal details to be completed by the student

1. UCAS number
2. Your title (tick one box only) Mr Mrs Miss Ms Other
3. Your first name(s) (in full)
4. Your surname (in full)
5. Your gender Male Female
6. Your date of birth (DD/MM/YYYY) 7. Your age (in years) on 01/09/2014
8. Your permanent home address
Postcode
9. Your telephone no.
10. Your email address
11. Do you have a disability or ongoing medical condition? Yes No
12. Have you ever been in Local Authority Care? Yes No
13. Are you estranged from your family? Yes No
14. Have you ever studied in higher education before, for a qualification such as HNC, HND or degree?
If yes, please give details of where you have studied previously and for how long.
15. In which country are you normally resident?
England Northern Ireland Scotland Wales Other please specify
16. Please indicate your household income: 16,000 or less 16,001- 25,000 25,000 or over
See notes on the back of the form for how this will be verified.
Part 2: Details of your studies to date and proposed LJMU course of study for September 2013 to be completed by the student
17. Course title
18. Mode of study: Full time Part time
19. What is the start date of your university course? (MM/YYYY)
20. How many units/subjects are you currently studying?
Are these at BTEC A2 IB Other please specify
academic year of entry2014/2015 date of receipt
LJMU undergraduate scholarships
Important:
n Please read the guidance notes on the back page before completing your application.
n Your application will not be considered if you do not answer all the appropriate sections and attach copies of
all relevant documents.
n Contact Student Advice for further information: studentadvice@ljmu.ac.uk (0151 904 6056/6057).
scholrs form 2014-5_scholrs form 11/11/2013 09:45 Page 1
21. Have you received an offer of a place at LJMU? Yes No
22. If YES, is this conditional? Yes No
Please list conditions of offer, including subjects and tariff points required
23. Have you accepted this offer? Yes No
24. Is LJMU your first choice? (Conditional Firm or Unconditional) Yes No
25. If NO, which is your first choice university?
(Your application cannot be considered until you have accepted your offer.)
Part 3: Supporting statement to be completed by tutor, mentor, headteacher, head of 6th form/college, etc.
26. Please indicate the students areas of excellence or skills - tick all that apply:
Academic Sports Volunteering Music Creative/Visual Arts
Performing Arts Other
Please give brief information about their skills or areas of excellence. Please also remember to attach a reference
on headed paper (see back page for details.)
27. Predicted grades and subjects
Qualification eg. A2/BTEC Course Subject Predicted Grades
Return to: Student Advice and Wellbeing, Aquinas Building, Maryland Street, Liverpool L1 9DE tel: 0151 904 6056/6057
Closing date: Friday 3 May 2014.
scholrs form 2014-5_scholrs form 11/11/2013 09:45 Page 2
28. Signed on behalf of school or college
Print name
29. Position
30. Address of school
31. Stamped by school/college
Part 4: Covering Statement (Student)
32. Please write a short statement (ideally word processed) and attach to the back of the form. This
statement, along with your UCAS points (predicted or actual) and your supporting evidence, such
as certificates, will inform LJMUs decision when awarding scholarships.
As a guide you should include information on n what you like, what you do in your spare time and your interests n why you
have chosen your specific course of study and what you hope to achieve n why you think you should receive a
scholarship.
Data Protection Act 1998
Liverpool John Moores University is a data controller in terms of the 1998 legislation. The Student Advice and Wellbeing Team follows University policy
in matters of data protection. The data requested in this form is covered by the notification provided by the University under the Data Protection Act.
Personal data will be used solely in the department for statistical purposes and electronic records keeping.The data will not be passed to any other third
party without your consent, except when the University is required to do so by law. Any formal enquiries concerning the use of data noted here should be
addressed to the Data Protection Officer, 2 Rodney Street, Liverpool L3 5UX.
Part 4: Student declarations
I certify that to the best of my knowledge, I fulfil the following criteria: (please tick the relevant boxes)
Either
There are no restrictions on my stay in the UK and I am therefore settled* within the United Kingdom (UK)
ie, have the Right of Abode in the UK.
or
I have been recognised by the UK Government as a Refugee and have Full Refugee Status/ILE/R as a result.
I am an EEA migrant worker.
I am an EU national and have been ordinarily resident within the EEA for three years before the start of the course.
I am the child/spouse of an EEA Migrant Worker.
*Settled on the first day of the first academic year of your course.
Return to: Student Advice and Wellbeing, Aquinas Building, Maryland Street, Liverpool L1 9DE tel: 0151 904 6056/6057
Closing date: Friday 3 May 2014.
scholrs form 2014-5_scholrs form 11/11/2013 09:45 Page 3
plus
I have been Ordinarily Resident within the UK and Islands for three years immediately before the start of my
course. (Anyone with ELE/R or anyone recognised by the UK Government as a Refugee should have maintained
Ordinary Residence from the date this status was granted).
I confirm that I will be registered and in attendance on the course described in Part 2 of this form from
September 2014 onwards.
I declare that the information that I have given on this form is correct and complete to the best of my knowledge.
I understand that giving false information will automatically disqualify my application and may also lead to disciplinary
procedures resulting in possible expulsion from the University. I further undertake to repay any grants obtained by me as a result.
Student name (CAPITALS) Student signature Date
Please ensure that the following photocopied documentation is attached to your application. Original documents will not be returned.
1. Documentary evidence of skills, achievements and areas of excellence. Please note that this information will form the basis of
LJMUs decision on who receives a scholarship. It is therefore in your interest to include as much photocopied evidence as
possible to support your application. This may include certificates, references, qualifications obtained to date, etc.
2. A letter/reference on headed paper from your tutor, head of sixth form or mentor. If you are not coming to study at LJMU straight from
school or college a reference from your employer or other suitable person will be acceptable. This must outline why they feel you should
be awarded an LJMU scholarship and detail any areas of excellence if applicable.
3. A covering letter.
Committee decision Appeal decision
Date
Category of award
Database (initials) Checked (initials)
Return to: Student Advice and Wellbeing, Aquinas Building, Maryland Street, Liverpool L1 9DE tel: 0151 904 6056/6057
Closing date: Friday 3 May 2014.
scholrs form 2014-5_scholrs form 11/11/2013 09:45 Page 4
This application form is for all LJMU scholarships for
the 2014/2015 academic year, including the National
Scholarship Programme (NSP). You only need to
complete this form in order to be considered for all of
LJMUs scholarships. You will be considered for all
scholarships where you meet the eligibility criteria,
increasing your chances of receiving an award.
Who is eligible to apply for LJMU scholarships?
n The National Scholarship Programme is open to both full-time
and part-time students from England or the EU who have a
household income of 16,000 or less. Applicants from Scotland,
Wales and Northern Ireland are not eligible for the National
Scholarship Programme.
n All other LJMU scholarships are open to full-time UK or EU
students as defined by the Department of Business Innovation
and Skills (BIS).
n Students must be commencing the first year of a first
undergraduate course.
n Students must be liable to pay the LJMU tuition fee of 9,000
payable via a tuition fee loan.
n Priority will be given to students that select LJMU as their 1st
(firm) choice via UCAS.
Who is not eligible?
n NHS-funded students
n Students on a course funded by the Training and Development
Agency for Schools (TDA).
n Students continuing on a course they started before
September 2014.
n Students transferring from one course to another that started
before September 2014 for example from an HND to an
undergraduate degree programme.
n Postgraduate students.
n Students on an integral foundation year of an undergraduate
programme as their first year tuition fees are already offered at a
reduced rate.
n Students that have studied in Higher Education previously,
regardless of where in the world that study took place or if a
qualification was achieved or not.
I am an EU national, can I apply?
n Yes EU nationals can apply for all of our scholarships.
Why do you need to know my income?
n The National Scholarship Programme is funded, in part, by the
Government. They have set certain criteria and one of them is
linked to household income. To be considered for this award at
LJMU, you must have a household income of 16,000 or less.
n If your National Scholarship Programme application is
successful, no scholarship funding will be paid to you until your
income is verified by the Student Loans Company.
Do I need to achieve a certain number of UCAS points to get
a scholarship?
n It depends. Some of our scholarships, such as the Dream Plan
Achieve Scholarship, are based purely on academic attainment;
others are a combination of UCAS points and other criteria such
as the National Scholarship Programme.
See the table on back of this form for more information.
What if I havent got UCAS tariff points?
n LJMU will consider applications from students without UCAS
points such as those coming to LJMU from an access course. We
will look at your relevant skills and experiences plus the
supporting statements submitted by you and your referee.
I am not at school or college who can give me a reference?
n Many of our students do not come to LJMU straight from
school or college. If you are in this category you should get a
reference from an employer or someone else who knows you
well and can comment appropriately on your skills and experience
(similar to a job reference). If you left school or college recently
your teachers may still be willing to offer you a reference.
How will we make a decision on who gets a scholarship?
n After the deadline has passed a committee will consider all the
applications based on either UCAS points (predicted or actual) or
other skills or qualities you have highlighted and documented.
n Final decisions will be based on your references and
supporting statement.
n We advise you to spend time thinking about what should go
in your statement, just like you would when completing a job
application.
n Once a decision has been reached, we will email you to let you
know the outcome. This will normally be one month after the
closing date for applications.
n Some applicants may be called to attend an interview.
n Decisions will be provisional if they are based on UCAS points
which will not be confirmed until mid-August.
When will you let me know?
n See above.
Where can I get more information?
t: 0151 904 6056/6057
e: studentadvice@ljmu.ac.uk
w: www.ljmu.ac.uk/feesandfunding
Return to: Student Advice and Wellbeing, Aquinas Building, Maryland Street, Liverpool L1 9DE tel: 0151 904 6056/6057
Closing date: Friday 3 May 2014.
scholrs form 2014-5_scholrs form 11/11/2013 09:45 Page 5
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scholrs form 2014-5_scholrs form 11/11/2013 09:45 Page 6