International MA in Economy, State and Society

with reference to Central and Eastern Europe

CATEGORY A ERASMUS MUNDUS SCHOLARSHIP

APPLICATION FORM for entry to IMESS in 2011/12
Please complete this form and return it with your UCL application form
and all associated documents.

You may submit all documents by post to:

Admissions, University College London, The Registry, Gower Street, London,

WC1E 6BT.

or online at:

www.ucl.ac.uk/prospective-students/graduate-study/application-
admission/apply-online/

NB: If applying online, applicants must upload this form (including

the scan of the
information page of their passport) under ‘Additional document’

Please check the application guidelines at http://www.imess.eu carefully.

Personal details
Surname: _____________________________
First name: _____________________________
Date of birth: _____________________________
Citizenship: _____________________________

Contact details
Street, number: _____________________________
Town/city: _____________________________
Country: _____________________________
Post code: _____________________________
Phone number: _____________________________

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E-mail: _____________________________

To be eligible for a Category A Erasmus Mundus Scholarship,

applicants:
- must not be a resident of an EU member-state or an EEA-EFTA state
- must not have carried out their main activity (studies, work, etc.) for
more than a total of 12 months over the last 5 years in one of the above
countries
- must not have received his/her last university degree from either of the
two countries in which he/she will study as part of the IMESS programme
- must not have previously received an Erasmus Mundus Scholarship
- must not have applied to more than 3 Erasmus Mundus programmes in
the same year
- must not be applying to study in Moscow in the second year

and

- must complete this form and return it, as instructed, no later than 17
December 2010 to be considered for an Erasmus Mundus Scholarship
commencing September 2011
- must have addressed all the requirements described in the IMESS
student application guidelines http://www.imess.eu/applications.html
- must attach a scan of the information page of their passport to the end of
this document.

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 DECLARATION

I hereby declare that:

- I am not a resident of an EU member-state or an EEA-EFTA state;

- I have not carried out my main activity (studies, work, etc.) for more than
a total of 12 months over the past five years in one of the above states;
- my last degree was not from a university in either of the two countries in
which I will study as part of the IMESS programme;
- I have not applied to more than 3 Erasmus Mundus programmes this year;
- I have not applied without fully understanding the English language
requirement and I have made clear my study track choice, language
choice and year 2 university choice.

I further confirm, by marking the boxes, in the application checklist,

below that:

 I have completed the UCL Application for Admission as a Graduate

Student and included all the required documentation requested therein.

 I have indicated in the Funding section of the UCL Application form that I

intend to apply for the Erasmus Mundus Scholarship.

 I have listed and explained my choice of language and study track in the

IMESS Supplementary Questionnaire.

 I have explained my motivation for wanting to attend the IMESS degree in

the IMESS Supplementary Questionnaire.

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 I have set out my research interests in the IMESS Supplementary

Questionnaire.

 I have uploaded (if applying online) or included (if sending by post) my

academic transcript (where not yet available (i.e. pending), please include

transcripts from completed years and/or courses; you will have a chance

to submit your final transcript at a later date).

 I have included (if sending by post) a copy of the information page of my

passport. If applying online, I have attached a copy of the information

page of my passport to the end of this document, which I have uploaded

under ‘Additional document’ on the online system.

 I have uploaded (if applying online) or included (if sending by post) a copy

of my English-language test results.

 I have arranged for academic references to be sent to UCL if not already

included in my posted materials.

 I have understood that the Erasmus Mundus scholarship of €24,000 per

year will not cover all of the costs associated with the programme. Tuition

fees (€14,800 per year), accommodation, travel and other living costs will

total more than €21,000 per year.

 I have not previously received an Erasmus Mundus Scholarship.

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___________________ _______________________________
Date Signature