Waymade Nursing Scholarship application form

Section 1: Your details
Please enter your contact information so that we can keep you up to date with your application status. Please note that you will be unable to save your progress whilst completing this form - ensure you have the information you need and your academic reference to hand as a separate document beforehand. You will be able to upload your academic reference on page five. A text box is also available on page five for students who are completing the form with their academic referee in person.
Your title:
MissMrsMrMsMx
Other title not listed (please type below):
Your name:

First name

Last name

Your date of birth (DD/MM/YYYY):
Your address:

Address Line 1

Address Line 2

City

County

Postcode

Country
Your contact phone number:
Your email address:

Please enter an email address you actively monitor in order to ensure you recieve any email updates relating to your application
How did you hear about the scholarship?

Section 2: Your course
Course title:
Are you the first member of your family to attend university?
YesNo
Section 3: Your eligibility
In order to be eligible for this scholarship, you will need to have a household income of £25,000 or below as assessed by Student Finance* for student funding purposes. In order for us to assess your eligibility, you must have an approved application for funding with Student Finance* to study at De Montfort University. Without this we will not be able to take your application any further.
Your Student Finance* Customer Reference Number:

*Student Finance England, Student Finance Wales, Student Finance Northern Ireland, SAAS
I can confirm I have an approved student finance application with Student Finance (e.g. *Student Finance England, Student Finance Wales, Student Finance Northern Ireland, SAAS)
YesNo

Please note: if you answer no and have submitted your application for the Scholarship prior to 27 August 2021, we will only be able to put your application forward if your student funding is approved by that date

Section 4: Your supporting information
What barriers (personal challenges, discrimination, disadvantage) did you have to overcome in order to attend University?
Which extra-curricular opportunities have you been involved in? What have been the benefits to you from these opportunities?
What makes you a good candidate to receive this scholarship?

Section 4 - continued: Your academic recommendation
Name

First name

Last name
Job title:
Email
Work phone number:
Please upload a document containing your academic recommendation:

For example, a Word or PDF file

Section 5: Equality & diversity
Please tick as appropriate.
Ethnic origin:
White - BritishWhite - IrishWhite - OtherAsian/Asian British - IndianAsian/Asian British - PakistaniAsian/Asian British - BangladeshiAsian/Asian British - OtherMixed - White & Black CarribeanMixed - White & Black AfricanMixed - White & AsianMixed - OtherBlack - BritishBlack - CarribeanBlack - AfricanOther ethnic group - ChineseOther ethnic group - Eastern EuropeanPrefer not to say
Age range:
16 - 2425 - 4041 - 5455 - 6566+
Do you have a disability and/or medical condition?
YesNo
If you have ticked “Yes” on the previous question, please provide details:

Section 6
Data Protection: De Montfort University processes data in accordance with the General Data Protection Regulation (GDPR) 2018. The personal information provided on these forms will be processed for purposes of allocation of the scholarships, any subsequent payments/fee waivers and any associated requirements of the university. Some of the information that you provide on this form may be sent to the Funding Councils, their agents and other statutory bodies for statistical and other purposes. Information relating to ethnicity and disability is collected by the university for monitoring purposes in accordance with the Equality Act 2010.
I agree
Declaration: I agree to De Montfort University processing the information provided on this form in line with the statement above and I declare that the information contained in this form is correct and I have not knowingly given false information. Any false information provided will result in the withdrawal of my application and the scholarship (if awarded).
I agree
Signed:

Enter your signature
Date: