Financial Support Office Undergraduate Scholarship Application Form
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13Financial Support Office
l
Undergraduate Scholarship Application Form
2016-17
Office use only
Departmental code
Reference
Please read the accompanying Guidance Notes before completing this form.
This form requires you to provide detailed information about your financial circumstances. All figures given must be in UK pounds
sterling (£).
Section 1 l Personal Information
1.1 LSE applicant number
1.2 Title (eg, Miss/Ms/Mr/Mrs)
1.3 Surname or family name
1.4 First name(s)
1.5 Date of birth (DD/MM/YYYY)
/
/
1.6 Address(es) between June – September 2016. Please give the dates that you will be at this address or addresses.
Address 1
Address 2
Dates
Dates
1.7 Contact details
Home tel
Email
Mobile tel
Fax
1.8 Country of permanent domicile
1.9 Nationality
FOR OFFICE USE ONLY
Amount Awarded
Name of Award
Decision (circle)
Taken by
Date
Initials
(£)/Decline Code
1
Award/Decline*
P/D/O
2
Award/Decline*
P/D/O
3
Award/Decline*
P/D/O
4
Award/Decline*
P/D/O
5
Award/Decline*
P/D/O
6
Award/Decline*
P/D/O
7
Award/Decline*
P/D/O
8
Award/Decline*
P/D/O
9
Award/Decline*
P/D/O
10
Award/Decline*
P/D/O
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