BG Tanzania Postgraduate Scholarship Scheme for Geoscience and Engineering Application form Please send by post officer the completed application form to: BG Tanzania Scholarship Scheme Application, BG Tanzania Scholarship Project, British Council, Samora Avenue/ Ohio Street, P.O.Box 9100, Dar es Salaam - Tanzania Please complete all parts of this form in black ink or typescript and attach a recent photograph of yourself. Also complete the enclosed Medical Clearence Form and send together with this appliocation form PHOTOGRAPH A note at the end of this form explains who will see the information you supply to us, and why. Please attach your latest CV, academic certificate, academic transcript and two letters of reference, preferably academic ones and medical forms. Without these documents your application will not be considered. Part A Personal details Family name (as in your passport) Other name(s) Title Mr Mrs Miss Ms Dr Sex Male Female Place of birth Date of birth Status Single Married Divorced Widowed Nationality Number of children (if applicable) BG Tanzania Scholarship Scheme for Geoscience and Engineering
Your address; where we should send letters Name, address of next of kin or person in your home country who should be contacted in the event of an emergency (please state relationship). Telephone number Mobile number Telephone number Mobile number Please tick this box to confirm that you have told your emergency contact that you have given us their details. Where are you currently working or studying? If you are currently working, please provide details of your post, grade and main responsibilities. Contact details of line manager Name of your line manager Position Department Organisation Address Telephone number Fax If you are currently studying, what qualification do you expect to obtain, and when do you expect to obtain it? 2 BG Tanzania National Scholarship Scheme for Geoscience and Engineering
Part B Academic background Please list all academic qualifications gained from secondary education, stating the institutions attended, the main subjects of study, and when the main courses started and finished. Please indicate with an asterisk (*) those courses that were entirely, or mostly, in English i.e. where the language of instruction or supervision was English. Please attach photocopies of all relevant academic certificates and transcripts, with accompanying translations into English if they are in another language. Qualification (including class or level) Institution Subject From To Part C Professional background Please list all positions held since completing your secondary or tertiary education. Position Organisation/institution From To 3 BG Tanzania National Scholarship Scheme for Geoscience and Engineering
Part D Proposed course of study to the University/ Institute in Tanzania What qualification would you like to obtain, and in which subject(s)? Its should be from Ardhi University, Dar Es Salaam Institute of Technology, University of Dar Es Salaam or University of Dodoma oonly. 1 At which institution would you like to study? Its should be from Ardhi University, Dar Es Salaam Institute of Technology, University of Dar Es Salaam or University of Dodoma only. Please attach photocopy of an offer/ admission letter 1 Are you applying for any other scholarships or awards to study in the local universities? If yes, please give full details. How did you get to know about the BG National Scholarship Scheme? My employer A colleague or friend Promotional literature Internet search Newspaper Other please specify Part E Referees Please attach letters from two (2) referees (one should be professional from your recent employer and one should be academic) in support of your application for a BG National Scholarship. Please provide details of the two referees below. If you are unable to attach letters from your referees, please ask them to write to us as soon as possible. First referee Title and name Position Telephone number Fax How long have you known this referee? What is his/her professional relationship to you? Second referee Title and name Position Telephone number Fax How long have you known this referee? What is his/her professional relationship to you? Please tick this box to confirm that you have informed your referees that you have given us their contact details. 4 BG Tanzania National Scholarship Scheme for Geoscience and Engineering
Part F Statements about yourself and your plans Personal statement What are your reasons for applying for the course you wish to study? Explain how it will help your career and personal development to Tanzania. Try to do this in no more than 500 words. Be brief we can explore the detail at interview if necessary. Your plans for the future Please provide an outline of your ambitions and career plan. How do you intend to make a difference in Tanzania? Try to do this in no more than 250 words. We can discuss your plans at interview. 5 BG Tanzania National Scholarship Scheme for Geoscience and Engineering
Are you a potential leader? The BG National Scholarship Scheme looks for future leaders, who can use their influence and standing to bring benefits to their communities and countries. Describe your most outstanding non-academic achievement where you demonstrated leadership potential. It should involve other people, and it may be an extra-curricular/sport/community/professional activity or an assignment. Try to do this in no more than 250 words. We can discuss it further at interview. 6 BG Tanzania National Scholarship Scheme for Geoscience and Engineering
Important information that you should read and understand before signing this application form The British Council will provide the following services in support of the BG National Scholarship Scheme: 1. Certficates/ documents attach mentioned/ important certificates/ transcripts only. 2. Selection of candidates full recruitment and selection of candidates, including general advice on entry requirements for study on postgraduate courses in Tanzania 3. English Language Proficiency All applicants should demonstrate IELTS level 5.5 to be considered for shortlisting together with other requirements. 4. Pre-enrollment briefings British Council will provide pre-enrollment briefing to scholars before they report to the participating local universities/ institutes. 5. Payment of scholar fees and allowances British Council will arrange the payment of scholar allowances. The range of scholar allowances is subject to prior approval but may include: tuition fees; monthly stipend/ allowances; thesis allowance; book allowances and other allowances as approved by BG Tanzania National Scholarship Scheme. 6. Welfare and disability support local universities will be the only point of contact for scholars with any welfare issues. Data Protection Thank you for providing us with information about yourself on this form. We will look after the information carefully and use it to consider your suitability for a Scholarship and to manage the application process. It will be made available to staff at the British Council and BG Tanzania. It may also be made available to members of any panel that interviews you. Your information may also be passed to participating higher education institutions in Tanzania to help secure a place on a course of your choice. After we know that you have a confirmed place on a course we will ask you again for permission to use the information in new ways that will become necessary as you proceed to take up your Scholarship. If you are unsuccessful the information will be held securely and destroyed in due course In signing this application form for a BG Tanzania National Schoalship for Geoscience and Engineering you accept that you will be bound by these conditions. You also accept that we will use the information you have given us in the ways we have described. Signature Date FOR OFFICIAL USE ONLY TO BE COMPLETED BY BRITISH COUNCIL Other documents attached to this form (please tick): Photograph Photocopies of academic certificates (and translations, if relevant) CV Letters from two referees English Language Test Certificate Medical Form 7 BG Tanzania National Scholarship Scheme for Geoscience and Engineering
Medical report form British Council, P.O.Box 9100,Dar es Salaam. Part 1 Candidate s declaration Failure to disclose important information may cause the award to be refused or cancelled. First name Last name Date of birth Address Recent photograph to be affixed here before examination Telephone Do you have any medical condition or disability? Do you take any regular medication? Have you ever had a serious accident? If you have answered yes to any of the above questions, please give brief details. Are you likely to need any special provisions or treatment during the period of your award? If yes, please give brief details. During the last five years have you been referred to a hospital or undergone X-ray or other investigations? If yes, please give brief details. Have you ever had a nervous breakdown or needed psychiatric advice? If yes, please give brief details. Please sign below, only in the presence of the examining doctor. Name Signature Date te: a chest X-ray report (not the actual X-ray) must be attached to this form. If there is any significant change in your condition in the interval between completing this form and statring of your award year in your own interest you must inform the British Council immediately. 8 BG Tanzania National Scholarship Scheme for Geoscience and Engineering
Part 2 Examining doctor s report We need to know whether the candidate is physically and mentally fit to undertake a course of study. While you will wish to tell the applicant about any finding requiring further investigation or treatment, your overall opinion is confidential to the British Council and should not be discussed with the candidate. Please seal the form to be delivered to British Council with confidentiality. General health and physique Height (cm) Urinalysis sugar Blood pressure (mm Hg) Weight (kg) Urinalysis albumin Sight and hearing Chest X-ray Please record any abnormal findings on general physical examination and any doubts you may have about the candidate s mental stability. Please comment on any statements in Part 1 of this form stating how you believe it may affect the course of study. Will the candidate require any special treatment or medical attention while studying? Please give brief details. Do you consider the candidate fit to undertake the proposed course? Name Address Signature Date For completion by the overseas British Council office (or Mission where there is not a British Council office). The medical examination report should be referred to British Council Manchester for advice on any abnormal findings. Name Signature Date 9 BG Tanzania National Scholarship Scheme for Geoscience and Engineering
Declaration of health British Council, P.O.Box 9100,Dar es Salaam. Your full name Date of birth Country I am pregnant. In the past 12 months I have received medical treatment. If you have answered yes to either question, please give brief details. I declare that I am in good health and fit to take up an award. Please give brief details and tell us if you are receiving medical treatment at present. Data Protection tice British Council will use the information you have given on this form and any statement that is provided by a medical professional to assess that you are fit to study. By signing and returning this form you consent to this process. Signed Date 10 BG Tanzania National Scholarship Scheme for Geoscience and Engineering