Medical Scholarship Program

MEDICAL SCHOLARSHIP PROGRAM APPLICATION FORM APPLICANT’S PERSONAL INFORMATION FULL NAME MARITAL STATUS

GENDER  MALE  FEMALE EMIRATE

DATE OF BIRTH MOBILE 1

NATIONALITY MOBILE 2 OR HOME TELEPHONE

UAE ID NUMBER: E-MAIL ADDRESS

EMPLOYMENT INFORMATION COMPANY

DESIGNATION

EMIRATE

WORK TELEPHONE

EDUCATION INFORMATION LIST IN CHRONOLOGICAL ORDER ALL COLLEGE/UNIVERSITY RECORDS STARTING WITH THE LAST INSTITUTION ATTENDED:

GPA or GRADUATION DEGREE SPECIALTY NAME OF INSTITUTION COUNTRY PERCENTAGE YEAR

SCHOLARSHIP FOR PROGRAM YOU ARE APPLYING FOR

INSTITUTION OFFICIAL ACCEPTANCE YES NO

PROGRAMME PROGRAM START DATE (month/year)

 MASTER PHD DURATION OF STUDY (in years)

EMPLOYMENT HISTORY NAME OF ORGANISATION DESIGNATION FROM TILL

REFERENCES

NAME OCCUPATION ORGANISATION TELEPHONE EMAIL BRIEFLY INDICATE HOW YOU KNOW THIS PERSON

PLEASE UPLOAD THE FOLLOWING DOCUMENTS TO COMPLETE THE APPLICATION  Curriculum Vitae  Passport copy  UAE ID Copy  Khulasat Al-Qaid Copy copy (if applicable)  Official acceptance from the institution you applied for  Official Academic Transcripts of all previous university degrees  TOEFL or IELTS Certificate  2 Letters of Recommendation  Personal Statement The personal statement is an integral part of your application and will assist Al Jalila Foundation to better understand you and your motivations for pursuing postgraduate medical studies. As a guide your personal statement should cover the following and be approximately 500 to 800 words in length: . Reflect who you are and what you have achieved . Provide examples of major accomplishments . Highlight what makes you an outstanding candidate for this scholarship

Today’s Date: ______

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